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COVID Vaccinemarioezeh2021-04-26T11:34:07+00:00

Covid Vaccines | CDC Request

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  • Allergic Reaction

    Have you ever had an allergic reaction to: (This would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.)

  • A component of a COVID-19 vaccine including either of the following:

    (This would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.)

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  • Vaccine Scheduling & Location

  • Choose if you are able to arrive at PrimeCare Facility or if you need our team to help service your business or school

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    611 W MAIN ST
    ARLINGTON, TX   76010-1008

    Questions, call 817-996-1092
  • By signing below, I hereby agree that the information I have given in this form is accurate and complete. I will receive COVID19 vaccine. I release and discharge all the employees, administrators, agents and governmental bodies from any and all claims.

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