Women ages 16 years and older who are pregnant and their permanent household residents 16 years and older *Pregnant women were not included in COVID-19 vaccine clinical trials; however, the risk of hospitalization and death from COVID-19 is thought to be significantly higher than the risk of vaccination. Pregnant women are encouraged to discuss vaccination with their health care provider.)
Technologically-dependent individuals ages 16 years or older and the household residents and caregivers of children under 16 years old who are technologically-dependent. Such as individuals who are ventilator-dependent, oxygen-dependent, with tracheostomy, wheelchair-bound due to high-risk medical condition, or require tube feedings, parenteral nutrition, or dialysis.
Individuals ages 16 years or older with immunocompromising conditions and the household residents and caregivers of children under 16 years old who have immunocompromising conditions. Such as individuals receiving chemotherapy, requiring daily oral steroids or other immunosuppressants, those with HIV/AIDS or other diagnosed high-risk immunodeficiency.
Household residents and caregivers of children under 16 years old who have complex congenital heart disease requiring ongoing medical management, such as Tetralogy of Fallot, hypoplastic left heart syndrome, and double outlet right ventricle, or qualify for the Katie Beckett waiver.
No Insurance Affidavit
Moderna Vaccine Information
What to bring to your appointment:
Completed Consent Form
If you have insurance, please bring your insurance card.
If you have Medicare, please bring your red, white & blue card.
If you do not have insurance, please complete the no insurance affidavit.