Covid 19 Vaccine Contact Form

*Disclaimer: This form is not HIPAA compliant. Please do not enter any sensitive or medical related information. Your contact information will not be sold or used for marketing purposes.


In an effort to assist with the fight against the pandemic, Women’s Medical Center will be administering the COVID-19 vaccination to our patients as well as members of the community, based on the current age and occupation requirements as defined by the Georgia Department of Health.


In order to receive the Covid 19 vaccine, you must have had no other  vaccines in the last 14 days, no monoclonal antibody treatment for COVID in last 90 days, and if you have had a recent COVID infection or exposure you must be out of quarantine or fully recovered and out of isolation.  You may get the flu vaccine any time in relation to the Covid vaccine.

We usually give Covid vaccines in our office on Fridays.  You will receive a text message with a confirmation date and time.  

If you are scheduled for vaccination, please print the Vaccination Consent Form and complete prior to your visit. The consent form will also be available on site. You will also need to bring a photo ID with you to your appointment.  

Click the link below for the Vaccination Consent Form:
http://womensmedical.com/wp-content/uploads/2021/01/COVID-19-Vaccine-Consent-Form-revised-12-14-2037093.pdf



Stay safe!

Women’s Medical Center  


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