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Yukon COVID Vaccination Clinic
COVID Clinic Pfizer and Moderna COVID vaccines will also be available for 1st, 2nd, or booster doses. A parent or guardian must be present at the time of the appointment for anyone under the age of 18. While we will try to honor COVID vaccine brand requests, first dose choice may be limited based on vaccine availability. Pediatric Pfizer COVID vaccine is currently available for 5 - 12 years. Pfizer COVID vaccine is currently available for 12 years and older. Moderna COVID vaccine is available for 18 years and older. Booster doses of Pfizer and Moderna are now available for individuals who received their second dose at least 6 months before their appointment and are at least 16 years of age. Janssen boosters are available at least 2 months after the first dose. Everyone ages 18 and older are now eligible for a booster shot. For information regarding the recent expansion of booster eligibility, please read CDC recommendations at the following link: COVID-19 Vaccine Booster Shots. Please dress with consideration to having your upper arm exposed. We suggest a short sleeve shirt, if possible. A post-vaccine monitoring period of at least 15 minutes is required. After registration - download & bring completed consent form to your appointment. Extra consent forms are available at check-in if you do not have access to a printer. Bring your health insurance card or a clear copy of both sides of the card. If you do not have health insurance you can receive COVID vaccine at no charge. DO NOT ATTEND THIS EVENT IF ARE FEELING SICK INCLUDING FEVER, COLD OR FLU LIKE SYMPTOMS, OR TESTED POSITIVE FOR COVID IN THE PREVIOUS 14 DAYS
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Are you requesting a COVID-19 booster dose?	Yes No
Services I'd like to receive	COVID-19 Vaccine

You will receive those immunizations as medically indicated by your health consultant staff. Vaccine Information Statements are available online here.

Need help? Contact us at Myclinicok@passporthealthusa.com

Passport Health is committed to keeping your personal data safe and we endeavor to take every reasonable precaution to ensure security. Passport Health complies with health care data reporting requirements of State and Federal authorities, as well as subpoenas, and may use or disclose data as required or requested for billing and payment purposes. Outside of this, access to your personal information is restricted to employees at Passport Health for internal purposes only and is never sold.

I consent to receiving immunizations from Passport Health. I have been given an opportunity to review the Vaccine Information Statements located here. At the time of my appointment I will be made aware of certain risks that may be associated with the vaccine(s) including the potential for allergic reaction and I will be offered the opportunity to ask questions and I believe that the benefits outweigh the risks. I assume full responsibility for any reactions that may result. I authorize Passport Health to disclose my health information to my state immunization registry, my physician, my employer and my insurance company. I authorize Passport Health to notify me of future health events, services or products. I hereby acknowledge receipt of Passport Health's Notice of Privacy Practices. If I am signing this consent on behalf of another individual, I hereby certify that I have the legal right to do so as the person's parent or legal guardian, pursuant to a health care power of attorney, pursuant to a court order, or pursuant to some other legal right to consent to health care for the individual. I agree that the insurer or payer listed above is my primary medical coverage and that I am responsible for payment if services are not covered for any reason or are subject to any co-pays, deductibles, coinsurance or prior authorizations.

COVID Clinic