DeKalb County Board of Health - 1A+ Logo

  • DeKalb County Board of Health - 1A+

  • COVID-19 Vaccination Registration Form

    PLEASE NOTE: Vaccine will be provided for Phase 1A+ individuals only and Georgia residents ONLY. No out of state residents are allowed.

    ---------------------------------------------------------------------------------

    We are in vaccination phase 1A+:

    • Healthcare workers in clinical settings (e.g., nurses, physicians, EMS, laboratory technicians, environmental services, etc)
    • Staff and residents of long-term care facilities
    • All law enforcement and fire personnel (including volunteer departments)
    • Adults aged 65 and older
    • Caregivers: family members, friends or neighbors who provide unpaid assistance to a person with a chronic illness or disabling condition.

  • Qualification Questions

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    Please contact your primary care provider to determine when you are eligible.

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    Please schedule an appointment when you have passed 14 days since you received any vaccination

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    A history of severe allergic reaction (e.g., anaphylaxis) to a previous dose or component of the COVID-19 vaccine product being offered is a contraindication to any current COVID-19 vaccine.

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    Please schedule an appointment when it has been more than 90 days since you received monoclonal antibodies or convalescent plasma.

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    Please schedule an appointment when you have completed your isolation or quarantine period.

  • I have a weakened immune system caused by something such as HIV infection or cancer or take immunosuppressive drugs or therapies.

    Persons with HIV infection or other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. mRNA COVID-19 vaccines may be administered to persons with underlying medical conditions who have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19, including wearing a mask, social distancing, and washing hands frequently.

    https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fpfizer%2Fclinical-considerations.html

  • I am currently pregnant, could possibly be pregnant, or I am breastfeeding

    CDC and the independent Advisory Committee on Immunization Practices (ACIP) have provided information to assist pregnant people with their decision to receive the COVID-19 vaccine. At this time, ACIP recommends that certain groups (e.g., healthcare personnel, followed by other frontline essential workers) are offered vaccination during the first months of the COVID-19 vaccination program. People who are pregnant and part of a group recommended to receive the COVID-19 vaccine may choose to be vaccinated. If they have questions about getting vaccinated, a discussion with a healthcare provider might help them make an informed decision.

    There are no data on the safety of COVID-19 vaccines in lactating people or the effects of mRNA COVID-19 vaccines on the breastfed infant or milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant. A lactating person who is part of a group recommended to receive a COVID-19 vaccine (e.g., healthcare personnel) may choose to be vaccinated.

    https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html

  • I have a bleeding disorder or taking a blood thinner?

    COVID-19 vaccine may be given to these patients, if a physician familiar with the patient’s bleeding risk determines that the vaccine can be administered intramuscularly with reasonable safety. Please discuss what bleeding disorder or blood thinner you are on with the provider vaccinating you prior to vaccination.

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    The registration has ended.

    Thank you for visiting the DeKalb County Board of Health registration form.

  • Vaccine Administration

    After completing this form, you will receive an email to select the date and time for your vaccine appointment.

  • Unfortunately, we do not have appointments for Pfizer vaccine available at this time.

    Please check back as we will be opening up appointments for Pfizer vaccine soon.

  • Vaccine History

    It is important to understand the history of any complications you may have had in the past. There may be several versions of COVID-19 vaccines and understanding your history will help to align you with the best options available for you.

  • Unfortunately, you are not currently eligible to receive a COVID-19 vaccination.

    A history of severe allergic reaction (e.g., anaphylaxis) to a previous dose or component of the COVID-19 vaccine product being offered is a contraindication to any current COVID-19 vaccine.

  • Severe allergic reaction

    History of severe allergic reaction (e.g., anaphylaxis) to a previous dose or
    component of the COVID-19 vaccine product being offered is a contraindication
    to any current COVID-19 vaccine

  • HIPAA NOTICE of Privacy Policy

    Please read the HIPAA Notice of Privacy Policy:
    https://www.dekalbhealth.net/wp-content/uploads/2020/12/HIPAA-Notice-of-Privacy-Practices-Information-Apr2015.pdf

  • Please read the Moderna EUA Fact Sheet for Recipients and Caregivers to under the benefits and risks of the COVID-19 vaccine

    https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine

  • Clear

  • Address:

    2994 Turner Hill Road
    Stonecrest, GA 30038
    United States

  • Address:

    Brandsmart USA
    5000 Motors Industrial Way
    Atlanta , GA 30360
    United States

  • Pre-existing conditions

  • Contact Information

  •  / /

  • Emergency Point of Contact

  • Insurance Information

  • Insurance Information

  • Medicaid / Medicare

     

  • Attestation

  • IMPORTANT:

    You will need to verify that you are in one of the eligible categories and will need to bring your driver’s license and insurance card, if applicable.

    Eligible groups in Phase 1A+ include:

        •    Healthcare workers (physicians, nurses, laboratory technicians, EMS personnel, environmental services, etc.

        •    Adults aged 65 and older (and their caregivers as applicable)

        •    Law enforcement, firefighters, first responders

        •    Residents and staff of long-term care facilities

     If you are a healthcare worker, law enforcement, firefighter, first responder, one of the following will be required:

        •    Your employer identification badge

        •    Your professional clinician’s license (must be active)

        •    Letter from your healthcare employer on company letterhead.

        •    Most recent pay stub from your healthcare employer showing current employment.

        •    Professionally printed business card identifying you as a frontline healthcare worker.

     

    Failure to provide the required documentation may result in your not being given this vaccine at this time. Appointments made by individuals not currently eligible for vaccine will be cancelled and they will not be vaccinated. Only those in one of the eligible categories above with a confirmed registration will be vaccinated. NO walk-in appointments are allowed. NO substitutions of people are allowed.

     

    PLEASE DO NOT ARRIVE MORE THAN 10 MINS EARLY FOR YOUR APPOINTMENT. If you do not arrive within 10 minutes of your scheduled appointment, your appointment will be cancelled.

  • Should be Empty: