Please print and fill out the first page of this form and bring it with you to your appointment.
https://www.cdc.gov/vaccines/covid-19/downloads/pre-vaccination-screening-form.pdf
This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n). This health center received HHS funding and has federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. For more information, please see https://bphc.hrsa.gov/ftca
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Family Health Services is an equal opportunity provider and employer.
