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 or have received antibody therapy for COVID-19 within the last 90 days you will need to reschedule.
Moderna Consent Form – English
Moderna Fact Sheet -English
Formulario de consentimiento de Moderna – Español
Hoja informativa de Moderna – 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
VSAFE Information Sheet – English
Hoja de información de VSAFE – Español
Pfizer (12 years and older):
Pfizer Fact Sheet – English
Pfizer Consent Form – English
Hoja informativa de Pfizer – Español
Formulario de consentimiento de Pfizer – Español
Pfizer (5-11 years old):
Pfizer 5-11 years – Screening/Consent Form
Pfizer 5-11 years – Fact Sheet
Pfizer 5-11 años – Hoja de consentimiento
Pfizer 5-11 años – Hoja informativa
Looking to get a Covid-19 Vaccine?
PHS offers Moderna, Johnson & Johnson, and Pfizer vaccine.
Individuals under the age of 19 must be accompained by a parent/guardian.
Walk-In Covid-19 Vaccine Clinics at PHS
*No appointment needed.
- Tuesdays from 9 a.m. to 12 p.m.
- Fridays from 3 p.m. to 5 p.m.
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
If you are homebound or have a disability that makes if difficult to get a Covid-19 vaccination, please call our office. A nurse will return your call and make sure you have access to a Covid vaccination.
Questions about the COVID-19 vaccines?
Visit the CDC website HERE to learn more.