MMC COVID-19 Vaccination Clinic Registration

Upcoming COVID-19 Vaccine Clinic Dates:

DATE: Thursday, April 15
TIME: 8 a.m. – 12 p.m.
LOCATION: Minden Medical Center (1 Medical Plaza Pl., Minden, LA 71055)
IMPORTANT NOTE: You must be age 18 or older on the date of the vaccination clinic in order to receive the Moderna COVID-19 vaccine. 
To register for your COVID-19 vaccine, fill out the form below completely and accurately. PRE-REGISTRATION IS REQUIRED. To register by phone, please call 318-382-8282. We are unable to schedule appointments by text, social media messages, or email.

PLEASE NOTE: The first dose of the MODERNA COVID-19 vaccine will be administered at the clinic dates listed above.
SECOND DOSE APPOINTMENTS: You will return to Minden Medical Center 28 days after your first dose to receive your second dose of the vaccine. Please DO NOT re-register for your second dose. 

  • If you received the first dose of the COVID-19 vaccine on Thursday, March 11, you will return to Minden Medical Center on Thursday, April 8, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, March 18, you will return to Minden Medical Center on Thursday, April 15, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, March 25, you will return to Minden Medical Center on Thursday, April 22, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, April 1, you will return to Minden Medical Center on Thursday, April 29, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, April 8, you will return to Minden Medical Center on Thursday, May 6, between 8am – 10am.
  • If you receive the first dose of the COVID-19 vaccine on Thursday, April 15, you will return to Minden Medical Center on Thursday, May 13, between 8am – 10am.

COVID-19 Vaccination Pre-Registration
Enter “NONE” if not applicable.
PLEASE NOTE: YOU MUST BE AGE 18 OR OLDER ON THE DATE OF VACCINATION IN ORDER TO RECEIVE THE MODERNA 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 1-3, 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 any vaccines in the past 14 days? *
NOTE: If "yes" you are NOT eligible to receive a COVID-19 vaccination. You must wait 14 days after the most recent vaccine was received.
3. 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.

SCREENING QUESTIONS CONTINUED:

4. 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.
5. I reviewed the EUA documentation regarding this vaccination. *
The Emergency Use Authorization documentation is linked below and can also be found here: https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-recipients.pdf
6. I agree to have the second dose in 28 days. *

COVID-19 Vaccination Appointment:

Registration is currently open for COVID-19 vaccination appointments on April 15. If you are coming for your second dose on this date, you do not need to re-register.
I meet the current COVID-19 vaccination criteria and I am willing to receive the COVID-19 vaccine. *

IMPORTANT LINKS:

PREPARING FOR YOUR APPOINTMENT:

  • Please arrive on time to your scheduled appointment and bring your ID and insurance card.
  • This is a drive-thru clinic and you will remain in your vehicle. 
  • Everyone will complete a COVID-19 vaccine screening upon check-in and will be under observation for 15 minutes or 30 minutes immediately after receiving the vaccine.
  • Masks are required to be worn at all times.

NOTE: Two shots are required to be fully vaccinated. You will return to Minden Medical Center 28 days after your first dose to receive your second dose of the vaccine. A reminder of the date and time of your second dose appointment will be provided to you at your first dose appointment. You will not need to re-register for your second dose appointment.

SECOND DOSE APPOINTMENTS DATES & TIMES:

  • If you received the first dose of the COVID-19 vaccine on Thursday, March 11, you will return to Minden Medical Center on Thursday, April 8, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, March 18, you will return to Minden Medical Center on Thursday, April 15, between 8am – 10am.
  • If you receive the first dose of the COVID-19 vaccine on Thursday, March 25, you will return to Minden Medical Center on Thursday, April 22, between 8am – 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, April 1, you will return to Minden Medical Center on Thursday, April 29, between 8am- 10am.
  • If you received the first dose of the COVID-19 vaccine on Thursday, April 8, you will return to Minden Medical Center on Thursday, May 6, between 8am – 10am.
  • If you receive the first dose of the COVID-19 vaccine on Thursday, April 15, you will return to Minden Medical Center on Thursday, May 13, between 8am – 10am.

Learn more about the COVID-19 vaccine: