If you have severe reactions with immunizations, please consult with your physician prior to registering for COVID-19 vaccination.
COVID-19 Vaccine is currently being distributed in a phased approach based on the recommendation of the Department of State Health Services and the Expert Vaccine Allocation Panel. This registration form will ask qualification questions and only allow registration if you meet the criteria.
According to State requirements, all adults that are eligible may register
PRIOR TO SUBMITING, please read the Emergency Use Authorization Fact Sheet for the Moderna COVID-19 vaccine on our website (
https://www.dpcareintexas.com/home) or directly from the CDC website (
https://www.cdc.gov/vaccines/covid-19/eua/index.html). You must be 16 or older to receive the Moderna vaccine.
By proceeding and giving consent, you acknowledge your understanding of the risk and benefits. IF YOU DO NOT CONSENT, YOU MUST NOT SUBMIT.
By checking 'I CONSENT' to the following question, you GIVE CONSENT to the Direct Primary Care in Texas to receive a COVID-19 vaccine.