**Vaccine supply is limited. Please keep your appointment or call if you need to cancel or change it. Additionally, due to vaccine requirements; we may call you to see if you can come earlier, later or to a nearby location. If you miss an appointment, no doses will be held to guarantee your dose.**
If you have remaining questions, please call us at (806) 435-3759
Section I. Personal Information
Currently we are only receiving the Moderna Vaccine. If you received the Pfizer vaccine as your first dose. It is required that you second dose be the same of the same manufacturer.
Section II. Questionnaire for Immunization
Section III. Appointment Scheduler
Section IV. Signature
I understand the benefits and risks of the COVID-19 vaccine as described in the Emergency Use Authorization (EUA) ( www.modernatx.com ), a copy of which I was provided with this Consent and Release. I have had a chance to ask questions that were answered to my satisfaction. I request the vaccine to be given to me.