UHWO Mobile Vaccination Clinic
UHWO/Queens COVID vaccination clinic 8/23 (7:30am-3:00pm)Please print and complete registration form, consent form (if under 18 years old), and pre-screening forms.
Consent Form (if under 18, parent signature is required):
COVID-19 Vaccine Pre-screening Form:
For immunocompromised individuals only.
If you are receiving a third dose, please also complete the following form:
EUA Fact sheets:
Last Name, First Name
Date of Birthday
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service