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COVID-19 Vaccine Consent and Administration Form

If you want to receive a COVID vaccine, please do so by filling out our consent form.
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Get in touch

For more information about our healthcare services, feel free to send us a message.

After entering your information, a link will be sent via email or text to preregister in our patient portal. Feel free to navigate the portal to complete patient documents as well as review education material.

PLEASE CHECK SPAM/JUNK mail if you don’t see the activation email.