Bay clinic COVID VACCINATION Event Scheduler
Please fill out the following information. Once completed, you will receive an EMAIL confirmation. Mahalo!
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Prefer not to say
Date of Birth
Age as of today
Phone Number (000-000-0000)
Home Address: (Street, City, State, Zip Code)
Which clinic day will you be attending?
12/4/21 KEIKI Clinic @ Keaau High School Gym 900am - 200pm
12/6/21 Bay Clinic COVID Clinic (305 Wailuku Dr. #2A) 830am - 400pm (closed 12-1pm)
12/7/21 Bay Clinic COVID Clinic (305 Wailuku Dr. #2A) 830am - 400pm (closed 12-1pm)
12/9/21 McDonald @ KONA COMMONS 11am - 200pm
12/11/21 KEIKI Clinic @ Kamehameha Middle School Gym 900am - 200pm
12/13/21 Bay Clinic COVID Clinic (305 Wailuku Dr. #2A) 830am - 400pm (closed 12-1pm)
12/14/21 Bay Clinic COVID Clinic (305 Wailuku Dr. #2A) 830am - 400pm (closed 12-1pm)
12/15/21 Keaau High School Cafeteria 130 pm - 400pm
12/17/21 Bay Clinic Kau 830am - 1100am
Choose the vaccination you would like to receive.
ADULT Primary series of Pfizer (2 doses - 21 days apart)
ADULT Primary series of Moderna (2 doses - 28 days apart)
ADULT Primary series of Johnson & Johnson (1 dose)
ADDITIONAL dose - IMMUNOCOMPROMISED PATIENTS ONLY (Moderna & Pfizer ONLY)
Johnson & Johnson Booster
PEDIATRIC PFIZER Primary series (2 doses - 21 days apart)
If you are scheduling an additional dose or booster dose, please indicate the date you received your 2nd dose (Moderna and Pfizer) or 1st dose for Johnson & Johnson.
If the patient is a minor, please provide the following information: Parent or Guardian's name, Date of Birth, and Relationship to the patient.
Please select all race(s) that apply to you:
American Indian or Alaska Native
Black or African American
Other Pacific Islander
Please select your ethnicity:
Hispanic or Latino
NOT Hispanic or Latino
Please let us know your preferred scheduled time.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Bay Clinic, Inc..