Jefferson Healthcare Vaccine Appointments

COVID-19 Vaccine Appointment Registration

PORT TOWNSEND, WASHINGTON
Jefferson Healthcare is offering vaccine appointments to residents of Jefferson County or those who live elsewhere and work in Jefferson County, Washington.
Name *

First Name Last Name
Date of Birth *

Month Day Year
**The Moderna vaccine can be give to individuals as young as 18 years old. If you are 16 or 17, please contact vaccineresponse@jeffersonhealthcare.org for more information.
Phone Number *
Please enter a valid phone number.
Email
Mailing Address *

Street Address or PO Box

Street Address Line 2

City

Zip Code
State *
Gender *

In the last 14 days, have you tested positive for COVID-19? *

Yes No
In the last 14 days, have you had exposure (without proper PPE) to anyone who tested positive for COVID-19? *

Yes No
Have you had a new onset of fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, nausea, vomiting or diarrhea? *

Yes No

You are not able to schedule an appointment at this time.

You are: not located in Washington State, or you have recently tested positive, had exposure to COVID or have a new onset of symptoms. You can contact the Jefferson Healthcare Respiratory Clinic for more information at 360-344-3094.

Have you previously had a severe allergic reaction/anaphylaxis after receiving a vaccine or other injected medication? *

Yes No
If you have had an immediate allergic reaction - even if it was not severe - to a vaccine or injectable medication, ask your doctor if you should get a COVID-19 vaccine before you make an appointment.
Have you received another vaccine (COVID-19 or any other vaccine) within the last 14 days? *

Yes No

You are not eligible to receive the COVID-19 vaccine if you have received any other vaccine within the last 14 days.

The vaccine requires two doses. Moderna doses must be spaced 4 weeks apart. Please select one option below. On the next page, you will choose one appointment time that will be applied to both dates. *

Moderna: First dose on April 14 and second dose on May 12 Moderna: First dose on April 16 and second dose on May 14

Please select one time below for your first dose.
We will automatically schedule your second dose at the same time.
Apr 7 and May 5 : Moderna *
Apr 8 and May 6 : Moderna *
Apr 14 and May 12 : Moderna *
Apr 16 and May 14 : Moderna *
Appt in Epic
Comments
All immunizations will occur by appointment only at the Jefferson Healthcare Drive-Thru Immunization Clinic located on 7th & Cleveland Street behind the Manresa Castle.

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Jefferson Healthcare is offering vaccine appointments to residents of Jefferson County or those who live elsewhere and work in Jefferson County, Washington.