Covid Vaccine/Booster

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1st Booster Shot

Moderna

Johnson & Johnson

Ages 5-17

2nd Booster

Your Information

Name1

First

Last

Type Vaccine1

Pfizer Infants: Ages 6 mo – 4 Years
Pfizer Pediatrics: Ages 5 – 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn’t received any doses of the covid vaccine.
Flu shot

Select Time

Is someone else being vaccinated or receiving the booster shot?

Name2

First

Last

Type Vaccine2

Pfizer Infants: Ages 6 mo – 4 Years
Pfizer Pediatrics: Ages 5 – 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn’t received any doses of the covid vaccine.
Flu shot

Select Time (copy)

Is someone else being vaccinated or receiving the booster shot2?

Name 3

First

Last

Type Vaccine3

Pfizer Infants: Ages 6 mo – 4 Years
Pfizer Pediatrics: Ages 5 – 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn’t received any doses of the covid vaccine.
Flu shot

Select Time3

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