This COVID-19 Vaccine request form is intended for individuals 18+ who are eligible to receive either the two dose Moderna  COVID-19 Vaccine or the one dose Johnson & Johnson (Janssen) COVID-19 Vaccine. Please note, only complete this form if you have NOT YET RECEIVED ANY COVID-19 Vaccine. If you need a second dose of Moderna or Pfizer, we encourage you to register with the Georgia Department of Health's Mass Vaccination Sites or use the Vaccine Finder to find your second dose: https://dph.georgia.gov/covid-vaccine 

Clarkston Community Health Center has received a limited supply of COVID-19 Vaccine. You must first complete this form and then select a scheduled time. When appointments slots become available, Clarkston Community Health Center will start contacting eligible patients.

Please review the COVID-19 Vaccine Fact sheets before you arrive:
 Moderna: https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-recipients.pdf 
Johnson & Johnson (Janssen): https://www.fda.gov/media/146305/download

Please review screening questions: https://www.cdc.gov/vaccines/covid-19/downloads/pre-vaccination-screening-form.pdf
CDC releases Johnson & Johnson Vaccine: https://www.cdc.gov/coronavirus/2019-ncov/downloads/talking-patients-jj-vaccine-html.pdf

A team member from Clarkston Community Health Center will call and text you with your appointment time, you must confirm the time through text or verbally immediately to confirm your time.

CCHC Vaccine Dates
Sunday, May 2, 2021 (5/2/21): Johnson & Johnson (Janssen) Only
Sunday, May 9, 2021 (5/9/21): J&J (Janssen) or Moderna
Sunday, May 16, 2021 (5/16/21): J&J (Janssen) or Moderna
Saturday, May 22, 2021 (5/22/21) J&J (Janssen or Moderna (11am-3pm)
Sunday, May 23, 2021 (5/23/21): J&J (Janssen) or Moderna
Sunday, May 30, 2021 - CLINIC CLOSED IN OBSERVANCE OF MEMORIAL DAY WEEKEND.
Sunday, June 6, 2021 (6/6/21):  J&J (Janssen) or Moderna
Sunday, June, 13, 2021 (6/13/21):  J&J (Janssen) or Moderna
Saturday, June 19, 2021 (6/19/21):  J&J (Janssen) or Moderna
Sunday, June 20, 2021  (6/20/21): J&J (Janssen) or Moderna
Saturday, June, 26, 2021 (6/26/21): Moderna
Sunday, June 27, 2021 (6/27/21): Moderna