COVID-19 Vaccination Forms
Individuals scheduled to receive a COVID-19 vaccination should fill out the Consent Form for the vaccine to be given and bring the completed form to your scheduled appointment.
Please note, if you currently have COVID-19, have received antibody therapy for COVID-19 within the last 90 days, or have received any other vaccine(s) in the two-week period before your appointment, you will need to reschedule.
Moderna Consent Form – English
Moderna Fact Sheet -English
Formulario de consentimiento de Moderna – Español
Hoja informativa de Moderna – Español
VSAFE Information Sheet – English
Hoja de información de VSAFE – Español
Johnson & Johnson:
Johnson & Johnson Consent Form – English
Johnson & Johnson Fact Sheet – English
Formulario de consentimiento de Johnson & Johnson – Español
Hoja de datos de Johnson & Johnson – Español
Pfizer Fact Sheet – English
Pfizer Consent Form – English
Hoja informativa de Pfizer – Español
Formulario de consentimiento de Pfizer – Español
COVID-19 Vaccine Information
PHS is now offering all three CDC-approved vaccines; Moderna, Johnson & Johnson, and Pfizer.
Beginning June 8, 2021
Walk-In Covid Vaccine Clinics at PHS
Every Tuesday from 10 a.m. to 12 p.m.
No appointment necessary.
Questions about the COVID-19 vaccines?
Visit the CDC website here to learn more.
Looking to get a COVID-19 Vaccine?
The PHS District offers multiple locations for individuals to receive a Covid-19 vaccination. To find a convenient location near you, check out our resource guide!
Download the COVID-19 Vaccine resource sheet
To view the Nebraska DHHS vaccine information page, click here.