COVID Vaccine Sign-up Steps:

1. Fill out the online sign-up form

 

 

2.At end of form, you will be able to schedule your 1st vaccine dose

3. Download a copy of the FDA Moderna Vaccine Emergency Use Authorization (EUA), Facts About COVID Vaccines, & What to expect after getting the COVID vaccine documents

(for your own information)

  (ENGLISH)                (ESPANOL)

4. Once you have submitted the sign-up form and booked your appointment and we have reviewed your form, you will receive a confirmation text message or phone call for your 1st dose appointment.

5. Your appointment is NOT CONFIRMED until you receive a confirmation text message or phone call

6. You will also get a phone call reminder the day prior to your appointment

7. We will automatically make you your 2nd dose appointment about 28 days after your 1st dose.

 

8. The day prior to your 2nd dose you will receive a phone call to confirm your 2nd dose appointment. You will NEED to fill out the 2nd dose form prior to your appointment. 

This form is required to receive your 2nd dose 28 days after your 1st dose. Please fill out the day before your 2nd dose appointment

Vaccine Information
 
We only carry the Moderna COVID-19 vaccine.  It is a 2 shot series given 28 days apart.
It is currently only authorized for persons 18 years old and up


For more information regarding the vaccine, please visit CDC or FDA websites.

What to expect at your appointment:

1. Arrive at our office at 19710 Fisher Ave, Suite J, Poolesville MD 20837

2. You will be greeted at our front desk and directed to a nurse for your vaccine

4. You will receive your vaccine and a CDC immunization card 

5. You will wait a minimum of 15 minutes for observation

6. You will check out with our front desk

We have partnered with WUMCO to assist community members that lack technology access:

For any person who needs assistance filling out our online form due to lack of internet or computer access, please call the WUMCO COVID Vaccine helpline at 240-812-9474 and leave a voicemail and a volunteer will call you back to assist you.

 

Important Information

COVID vaccine appointments will only be made using this online scheduling method (even for existing patients)

We will NOT accept ANY Walk-ins under any circumstances.

Appointments are on Wednesdays only.

Due to the storage and handling requirements, COVID vaccines will NOT be given during regular office visits

COST: There is absolutely no cost to the patient. The federal government is supplying the vaccine for free. We do charge a vaccine administration fee to your insurance but we do not collect any co-pays or deductibles from you. 

If you don't have health insurance, we are offering the vaccine completely free of charge.

We ask only the person with an appointment come to the visit. Only exception is for a person needing assistance.


 

We are offering the vaccine as a community service. Our small staff does not have the resources to answer specific questions about the vaccine (other than for our own patients). If you have questions, please contact your own physician or visit the CDC 

Email is best way to reach us:
CovidClinic@poolesvillefamilypractice.com
 

Doing this form online will make your 2nd appointment faster and more efficient with less waiting

You will NEED to fill out the 2nd dose form prior to your 2nd dose appointment.

Please fill it out 1-2 days prior to your 2nd appointment