Important Links
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This should be filled out electronically here. If you are unable to do so, please print this pdf form, fill it out and bring it the day of your appointment.
Anyone who cannot answer 'no' to questions 1-4 should not come to the clinic and will be rescheduled. Anyone who cannot answer 'no' to questions 5-11 should consult their own physician before registering for a vaccination. New York State Department of Health requests all individuals across New York State to self-report select demographic data such as occupation, race, and ethnicity prior to vaccine administration. This information is critically important for tracking vaccination progress throughout the State and ensuring appropriate vaccine distributions in all regions of the state.
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These fact sheets are written by the vaccine manufacturers specifically for patients and their caregivers to provide more information about the vaccine you receive and what to expect afterwards.
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V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination. Through v-safe, you can quickly tell CDC if you have any side effects after getting the COVID-19 vaccine. Depending on your answers, someone from CDC may call to check on you. And v-safe will remind you to get your second COVID-19 vaccine dose if you need one.
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