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Welcome To The Big Trees MD Flu & COVID-19 Vaccine Clinic Signup
To get registered for your vaccine(s), please fill out and submit this form.
38Questions
  • 1

    Dear Patients,

    Big Trees MD is administering vaccines to help protect against virus strains like Flu and COVID-19 that are expected to circulate this year. Insurance will be billed for your vaccine. If you are looking to vaccinate your child, depending on whether they’ve gotten influenza vaccines in the past, some children younger than nine years of age will need two doses of vaccine spaced about 4 weeks apart.

    If you have any questions about the vaccine or the vaccination clinics, or if you'd like the vaccine but do not have insurance, please call/text VACCINE to 209-653-2135 from 8 AM to 5 PM, M-F.

    We are NOT vaccinating against RSV at this time. For an RSV vaccine, visit: https://www.abrysvo.com/find-a-vaccine

    Please visit the CDC’s influenza website at http://www.cdc.gov/flu/ and also https://www.cdc.gov/flu/highrisk/children.htm for information, especially for parents.

    Sincerely,

    The Big Trees MD Team

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  • 2

    If you do not have insurance and you would still like to get vaccinated, please call/text VACCINE to Big Trees MD at 209-653-2135 from 8 AM to 5 PM, M-F. The remaining form is for those with insurance. 

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  • 3

    You will need pictures of the FRONT and BACK of your insurance card(s) and, if you have one, your PHARMACY BENEFIT CARD, before continuing. If you do not have these, please go get them and take pictures of the front and back of each card so you can complete your registraton.

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  • 4

    The Big Trees MD Flu and COVID-19 vaccine clinics will be held from 3-6pm on SEPTEMBER 29th* and OCTOBER 20th at Big Trees MD - 874 Henry St. Unit 4.

    *COVID-19 vaccine administration at the Sept. 29th. clinic will be pending availability.

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    This is so we can text confirmations/reminders about vaccine appointments.
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  • 12
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  • 13
    This means has the person receiving the vaccine ever needed an Epipen injection or had hospitalization or severe respiratory distress following a vaccination?
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  • 15
    *Two doses given at least four weeks apart are recommended for children age 6 months through 8 years of age who are getting an influenza (flu) vaccine for the first time 
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  • 18
    *If YES, it is recommended to space live vaccines by > 4 weeks for full efficacy
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  • 28

    There is not a COVID-19 Vaccine Information Statement. COVID-19 vaccine is currently available through Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA). EUA Fact Sheets for Recipients shall be provided to patients at the time of vaccination.

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  • 33
    Drag and drop files here
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  • 34
    We will need these to bill your vaccine to your insurance.
    Drag and drop files here
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    Max. file size: 10.6MB
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  • 35
    This can be found in your insurance card
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  • 36
    Choose one. Clinics will be from 3-6pm PST. 874 Henry St. Unit 4 Arnold, CA 95223. IMPORTANT!!!!!! LAST DAY TO REGISTER FOR the 9/29 clinic is 9/22/23 and LAST DAY TO REGISTER FOR THE OCTOBER 20th clinic is Oct 13th.
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  • 37
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