Wait List for Your 2nd Pfizer Vaccine

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Congratulations for completing the first PFIZER dose of your COVID-19 vaccination.

PLEASE READ ALL INFORMATION BEFORE YOU COMPLETE THIS FORM.

1. Appointments are not made on the day you receive your first vaccine. When our Immunizations Department received the shipment of 2nd doses, we will then contact you to make an appointment for your 2nd vaccine.

** Complete this form only once. Multiple entries may delay your appointment. **

** Please provide a working cell phone and email address you check often. **

2. You are REQUIRED to bring the "COVID-19 Vaccination Record Card" that you were provided when you received your first dose of the Pfizer vaccine.

The listed date on your "COVID-19 Vaccination Record Card" for your 2nd dose is only the 1st day that you are allowed to receive your 2nd dose and is NOT intended to be the only day that you can receive your 2nd dose.

3. Bring your health insurance information if you have it.

Receiving the COVID vaccine is free; however, there are costs associated with providing this service to the community, including supplies and staffing, that are being absorbed by NET Health.

The NET Health Immunizations Department asks that you bring proof of health insurance on the day that you return for your 2nd appointment, so that we can bill your health insurance provider to help us cover these administrative costs of providing the Pfizer vaccine to you free of charge.

3. The second dose can be given on any day AFTER 20 days since your first dose. NET Health will schedule you when we have received sufficient supply of the COVID-19 vaccine to be able to provide second doses.

Please be patient if we schedule your 2nd appointment after 21 days since your first dose.

4. Completion of the form below does not schedule you for an appointment.

After you fully complete the form below, WAIT to receive an automated email from Sign Up Genius that will display the next available days and times for you to select an appointment at our vaccine clinic.

When you receive that email, you may THEN sign up for your second dose of the Pfizer vaccine.

5. Thank you again for trusting NET Health with your health!

On what day did you receive your first dose of the Pfizer vaccine? (PLEASE only enter the Month and the Day - example: March 9th, March 17th, etc.) *

Where did you receive your first Pfizer vaccine? (please include the name of the facility and the city where it is located - Example: Harvey Convention Center in Tyler)

First Name *

Only enter the person's first name

Last Name *

Only enter the person's last name

City Where You Live

In what city do you live?

Zip Code of Your Residence

5-digit zip code

Please enter your email address.

What is your preferred email address for us contact you?

Please enter a cell phone number

We need to be able to contact you to schedule a future appointment.

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