COVID vaccine 2nd Dose (MODERNA) Scheduling Request
If you received your 1st Moderna dose through FHS AND have not received an appointment confirmation for the 2nd dose (be sure to check Inbox and Junk folder both), then please fill out this form so we can help you get scheduled for the 2nd dose.

IF YOU WANT TO RESCHEDULE AN EXISTING APPOINTMENT, please tell us that in the last field in this form with details of when you want to reschedule it to.

The CDC guideline to get 2nd dose of Moderna is within 28-42 days after 1st dose.

Upcoming 2nd Moderna dose (with appointment) date at the FHS ER at 3620 E Whitestone Blvd (drive-through) is:
May 19: 9 am - 5 pm

We may not be able to honor any special request at this time.
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Who was the provider of your first Moderna vaccine? *
If you have not received 1st vaccine through FHS, we will still try to get you scheduled for 2nd vaccine but it is not guaranteed.  
When did you receive your first dose? *
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First Name *
Last Name *
What is your date of birth *
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Please enter email address as used in 1st dose registration *
Please enter your phone number *
Anything else you want to let us know
I agree that the information I have provided above may be released and exchanged with volunteers and healthcare providers for the purpose of scheduling an appointment to receive COVID-19 vaccine *
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