MMC COVID-19 Vaccination Clinic Registration

Registration for the COVID-19 Vaccine Clinic at Minden Medical Center is now OPEN.

THE 12/2/2021 & 12/3/2021 CLINICS ARE FOR INDIVIDUALS WHO ARE RECEIVING THEIR FIRST SHOT, SECOND SHOT OR A BOOSTER SHOT.


NOTE: Two shots are required to be fully vaccinated. This clinic is for people receiving their first shot, second shot OR a booster shot.

Learn more about the COVID-19 vaccine:

COVID-19 Vaccination Pre-Registration - December 2-3, 2021
Enter “NONE” if not applicable.
PLEASE NOTE: YOU MUST BE AGE 12 OR OLDER ON THE DATE OF VACCINATION IN ORDER TO RECEIVE THE PFIZER COVID-19 VACCINE.
Example Format: 012-345-6789
Example Format: 123-45-6789
Enter “NONE” if not applicable.
Enter “NONE” if not applicable.
Enter “NONE” if not applicable.
Enter "NONE" if not applicable.

SCREENING QUESTIONS

IMPORTANT NOTE: If you answer "Yes" to any of Screening Questions 1-2, you are not currently eligible to receive the COVID-19 vaccine at this time.
1. Have you had any COVID antibody treatments within the last 3 months? *
NOTE: If "yes" you are NOT eligible to receive the COVID-19 vaccination. You must wait 90 days after the antibody treatment to receive a COVID-19 vaccination.
2. Have you had COVID-19 in the last 21 days? *
NOTE: If "yes" you are NOT eligible to receive the COVID-19 vaccination at this time. You must be negative for COVID-19 for 21 days.
3. Are you a healthcare worker? *
4. Are you a Minden Medical Center Employee? *

SCREENING QUESTIONS CONTINUED:

5. Have you been vaccinated for COVID-19 in the past? *
NOTE: This clinic is for individuals who are in need of their first shot, second shot OR booster shot. As such, this answer is defaulted to YES.
5c. Has it been at least 6 months since your second Pfizer or Moderna Vaccination or 2 months since your Johnson & Johnson vaccination?
NOTE: You must affirm that it has been at least 6 months since your second Pfizer or Moderna Vaccination or 2 months since your Johnson & Johnson vaccination
6. Do you have any severe anaphylactic allergies (food, vaccine, medications, insect, etc.)? *
NOTE: Everyone will be under observation for 15 minutes after receiving the vaccine or 30 minutes if you have ever had an allergic reaction to anything in order to qualify for a third vaccination dose.
7. I reviewed the EUA documentation regarding this vaccination. *
The Emergency Use Authorization documentation is linked above and can also be found here: https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-recipients.pdf
8. I agree to have the second dose in 21 days. *

COVID-19 Vaccination Appointment:

Registration is currently open for First Dose, Second Dose, OR Booster COVID-19 vaccination appointments on December 2 & 3, 2021.
I meet the current COVID-19 vaccination criteria and I am willing to receive the COVID-19 vaccine. *