Make An Appointment

First Name

Last Name

Date of Birth

Sex

Primary Contact Phone#

Your Email

Do you have a mobility issue that makes it difficult
for you to walk or physically enter a building?

Yes

No

Any other information you'd like to include? Please do not include additional health information. This will be gathered at the time of your appointment.

Prescreening - Have you been vaccinated for Covid-19?

Which vaccine do you want to receive?

Pfizer (5 years and older)

I want the Pfizer 1st, 2nd, or 3rd (additional) dose:
- 5 years and older:
  - It has been at least 3 weeks since my 1st dose.
    OR
  - I meet the criteria for moderate to severe immunocompromised and need a 3rd dose. It has been 28 days since my 2nd COVID-19 vaccination.
I want the Pfizer booster dose #1:
- 12 years and older:
  - It has been 5 months since my 2nd Pfizer or Moderna COVID-19 vaccination.
    OR
  - I meet the criteria for moderate to severe immunocompromised and has been 3 months since my 2nd Pfizer or Moderna COVID-19 vaccination
    OR
  - It has been at least 2 months since my 1st dose of Johnson & Johnson.
I want the Pfizer booster dose #2:
- 12-49 years old:
  - I meet the criteria for moderate to severe immunocompromised and has been 4 months since my 1st booster dose.
- 18-49 years old AND received Johnson & Johnson COVID-19 vaccine for BOTH primary and 1st booster dose and has been at least 4 months since 1st booster dose.
- 50 years and older
  - It has been 4 months since my 1st booster dose.

Moderna (18 and older)

I want the Moderna 1st, 2nd, or 3rd (additional) dose:
- 18 years and older:
  - It has been at least 4 weeks since my 1st dose
    OR
  - I meet the criteria for moderate to severe immunocompromised and need a 3rd dose. It has been 28 days since my 2nd COVID-19 vaccination.
I want the Moderna booster dose #1:
- 18 years and older:
  - It has been 5 months since my 2nd Pfizer or Moderna COVID-19 vaccination.
    OR
  - I meet the criteria for moderate to severe immunocompromised and has been 3 months since my 2nd Pfizer or Moderna COVID-19 vaccination.
    OR
  - It has been at least 2 months since my 1st dose of Johnson & Johnson.
I want the Moderna booster dose #2:
- 12-49 years old
  - I meet the criteria for moderate to severe immunocompromised and has been 4 months since my 1st booster dose.
- 18-49 years old AND received Johnson & Johnson COVID-19 vaccine for BOTH primary and 1st booster dose and has been at least 4 months since 1st booster dose.
- 50 years and older
  - It has been 4 months since my 1st booster dose.

Johnson & Johnson (18 and older)

I want the single dose of Johnson & Johnson COVID-19.
It has been 2 months since my last Johnson & Johnson COVID-19 vaccine.
It has been at least 5 months since my last mRNA COVID vaccination (i.e. Pfizer and Moderna)
(Note- J&J is not authorized for a 2nd COVID booster)

FCCHD Vaccine Clinic Appointment Scheduling Form

NOTICE

Personal Information

Vaccination Prescreening

Prescreening - Have you been vaccinated for Covid-19?

Please select your vaccine preference:

Which vaccine do you want to receive?

Please call (406) 751-8119 to schedule.

At this time, people who got the J&J/Janssen vaccine are
not eligible for a booster shot.
Click here for more information.

Which follow-up vaccine dose do you need?

Schedule Your Appointment

Choose a time slot for :

FCCHD Vaccine Clinic Appointment Scheduling Form

NOTICE

Personal Information

Vaccination Prescreening

Prescreening - Have you been vaccinated for Covid-19?

Please select your vaccine preference:

Which vaccine do you want to receive?

Please call (406) 751-8119 to schedule.

At this time, people who got the J&J/Janssen vaccine are not eligible for a booster shot. Click here for more information.

Which follow-up vaccine dose do you need?

Schedule Your Appointment

Choose a time slot for :

Vaccination Appointment Scheduler - Status

At this time, people who got the J&J/Janssen vaccine are
not eligible for a booster shot.
Click here for more information.