Covid 19 Vaccine Event

  • Documents to be completed for vaccination

    *Documents required to be completed for vaccination (preferable to be completed prior to arriving at vaccine clinic):

    • Patient Consent Questionnaire Form:

      • English: Spanish: 
      • Important note:  Parent/Guardian of unaccompanied minors must initial/sign/date the “Parent/Legal Guardian” line in section C prior to sending their minor to the vaccination clinic.
    • Insurance Attestation Form:

      • English:  Spanish: 
    • Unaccompanied Minor Consent Form: 

      (to be completed at home by a parent/guardian if the minor will be unaccompanied during vaccination)
      • Important note:  We will not vaccinate any unaccompanied minor who does not have a completed Unaccompanied Minor Consent Form in his/her possession.

    Scheduling Links:

    https://app.myirmobile.com/auth/register

    https://app.myirmobile.com/auth/event/79da7b1a-bd7f-11eb-a840-e7065952e45e