Schedule a vaccine appointment

Are you sick today? *

Have you ever had a serious reaction after receiving a vaccination? *

Do you have allergies to medications, food, a vaccine ingredient, or latex? *

Have you had a seizure or a brain or other nervous system problem such as Guillain-Barre syndrome? [Flu Shot] *

Have you ever been diagnosed with a heart condition (myocarditis or pericarditis) or have you had Multisystem Inflammatory Syndrome (MIS-A or MIS-C) after an infection with the virus that causes COVID-19? [Covid Vaccine] *

Do you have allergies to medications, food, eggs, yeast, a vaccine component, or latex? *

Has any physician or other healthcare professional ever cautioned or warned you about receiving certain vaccines or receiving vaccines outside of a medical setting? *

Do you have a long-term health problem such as heart disease, lung disease, liver disease, asthma, kidney disease, metabolic disease (e.g., diabetes) anemia or other blood disorder? *

Do you have cancer, leukemia, HIV/AIDS, or any other immune system problem? Have you been diagnosed with rheumatoid arthritis, ankylosing spondylitis, Crohn?s disease, herpes, or cold sores? *

In the past 3 months, have you taken medications that weaken your immune system such as cortisone, prednisone, other steroids, or anticancer drugs, or have you had radiation treatments? *

Have you had a seizure or a brain or other nervous system problem or Guillain Barre? *

During the past year, have you received a transfusion of blood or blood products, or been given immune (gamma) globulin or antiviral drug (including acyclovir famciclovir, valacyclovir)? *

For women: Are you pregnant or is there a chance you could become pregnant during the next month? *

Have you received any vaccinations or TB skin test in the past 4 weeks? *

Do you have a history of fainting, particularly with vaccines? *

For Tdap and adult Td: Do you have a cut, injury, puncture or open wound that prompted you to get a tetanus shot? *