Covid-19 VACCINATION Information

 

HOW TO REGISTER FOR OUR PHARMACY’S COVID-19 VACCINATION

 

FOR IndiVIDUALS: Walk-ins welcomed OR BOOK ONLINE

WALK-IN AVAILABILITY

Monday – friday | 8am – 6pm

SATURDAY | 8AM – 5PM

SUNDAY | 1PM – 5PM

 

TO BOOK ONLINE FOR MODERNA OR PFIZER GO TO LINK BELOW

perronepharmacy.simplybook.me

(ABAJO, SE PUEDE VER FORMAS Y INSTRUCCIONES EN ESPANOL)

 

FOR INDIVIDUALS SEEKING VACCINES:

You can register two ways:

You may call the Perrone Pharmacy COVID HOTLINE 682-404-8796 and leave your name and a telephone number to have the pharmacy call you back and schedule you an appointment for our in-store clinics. If you are with a group or school holding a vaccine clinic not on the pharmacy’s premises, please also leave the name of the group with whom you are associated in your voice message.

Or you can book online at: perronepharmacy.simplybook.me We open up dates weekly for in-store vaccine clinics.

YOU ARE ENCOURAGED TO COMPLETE THE REQUIRED FORMS BEFORE THE CLINIC

If the person to be vaccinated is over eighteen (18), then please fill out FORMS 1 and 2 only.

If the person to be vaccinated is between the ages of twelve (12) and seventeen (17), please fill out FORMS 1 and 3 only. You must sign as the parent/guardian on both FORMS 1 and 3.

IF, FOR ANY REASON, you as the parent/guardian cannot accompany your minor child to the COVID vaccine clinic, then YOU MUST FILL OUT AND SIGN FORM 4. Otherwise, your child cannot be vaccinated.

 

PLEASE BRING WITH YOU ON THE DAY OF THE CLINIC:

1.) A PHOTO ID of the person to be vaccinated with birth date on it (passport, driver’s license, learner’s permit). If no PHOTO ID is available, please bring a birth certificate or an immunization record or official school record showing the birth date of the person to be vaccinated;

2.) If the person to be vaccinated has a Social Security Number, please bring the number with you (you do not need to bring the card itself);

3.) If you have any medical/prescription drug coverage on the person to be vaccinated (such as Blue Cross Blue Shield, Medicaid, etc.), you must bring the insurance card with you.

If you have not filled out the paperwork before the clinic, please arrive fifteen (15) minutes before your appointment to complete the forms. Blank forms will also be available at the clinic. You and your children will need to wear a mask.

 

POR LOS INDIVIDUALES QUIEN QUIEREN LA VACUNA:

Les agradeceriamos mucho si pueden llenar los documentos necesarios antes de la clinica. Si su hijo/a es mayor de los 18 años por favor llenar los 2 documentos necesarios. Si su hijo/a estan entre la edad de 12 y 17 por favor completar la forma numero 1 y 3. Usted como padre/madre o guardian legal debe firmar estos documentos necesarios. Si por alguna razon no puede acompanar a su hijo a la clinica para poder administrar la vacuna para COVID debe llenar la forma numero 4. Al no llenar el documento su hijo/a no podra ser vacunada.

Debe de traer los documentos siguientes el dia de la clinica:

1) Una forma de identificacion del estudiante con la fecha de nacimiento.

(Pasaporte, licencia, permiso de aprendizaje de conducir) Si por algun motivo no tienen una de estas formas de identificacion por favor traer la acta de nacimiento, o un documento oficial de la escuela que tenga la fecha de nacimiento de su hijo/a.

2) Si tienen, el numero de seguro social del estudiante. (No ocupan traer fisicamente la tarjeta del seguro social)

3) Si tienen, alguna tarjeta de seguro medico por favor presentarla el dia de la clinica.

(Ejemplos: Medicaid, Blue Cross BlueShield, o otros seguros medicos comerciales) Si no puede llenar los documentos necesarios antes del dia de la clinica por favor llegar 15 minutos antes de la hora de su cita para completar los documentos. Tendremos todos los documentos disponibles el dia de la clinica para usted.

 

FOR SCHOOL STUDENTS OR OTHER GROUPS WANTING TO MAKE AN APPOINTMENT:

You can register two ways:

You may call the Perrone Pharmacy COVID HOTLINE 682-404-8796 and leave your name and a telephone number to have the pharmacy call you back and schedule you an appointment for a group/school clinic. Please leave the name of the group with whom you are associated in your voice message.

Or you can book online by using the URL assigned to your group. Please reference your group URL.

YOU ARE ENCOURAGED TO COMPLETE THE REQUIRED FORMS BEFORE THE SCHOOL/GROUP CLINIC

If the person to be vaccinated is over eighteen (18), then please fill out FORMS 1 and 2 only. You will find all FORMS listed below.

If the person to be vaccinated is between the ages of twelve (12) and seventeen (17), please fill out FORMS 1 and 3 only. You must sign as the parent/guardian on both FORMS 1 and 3.

IF, FOR ANY REASON, you as the parent/guardian cannot accompany your minor child to the COVID vaccine clinic, then YOU MUST FILL OUT AND SIGN FORM 4. Otherwise, your child cannot be vaccinated.

 

PLEASE BRING WITH YOU ON THE DAY OF THE CLINIC: 

1) PHOTO ID of person to be vaccinated which shows the birth date on it (passport, driver’s license, learner’s permit). If no PHOTO ID is available, please bring a birth certificate or an immunization record or official school record showing the birth date of the person to be vaccinated;

2) If any, the Social Security Number of the person to be vaccinated (you do not need to bring the card itself); 

3) If you have any medical/prescription drug coverage on the person to be vaccinated (such as Blue Cross Blue Shield, Medicaid, etc.), you must bring the insurance card with you.

If you have not filled out the paperwork before the clinic, please arrive fifteen (15) minutes before your appointment to complete the forms. Blank forms will also be available at the clinic. Please make certain all person wear masks to the clinic.

 

POR LOS ESTUDIENTES Y OTROS CON GRUPOS:

Les agradeceriamos mucho si pueden llenar los documentos necesarios antes de la clinica. Si su hijo/a es mayor de los 18 años por favor llenar los 2 documentos necesarios. Si su hijo/a estan entre la edad de 12 y 17 por favor completar la forma numero 1 y 3. Usted como padre/madre o guardian legal debe firmar estos documentos necesarios. Si por alguna razon no puede acompanar a su hijo a la clinica para poder administrar la vacuna para COVID debe llenar la forma numero 4. Al no llenar el documento su hijo/a no podra ser vacunada.

 

Debe de traer los documentos siguientes el dia de la clinica:

1) Una forma de identificacion del estudiante con la fecha de nacimiento.

(Pasaporte, licencia, permiso de aprendizaje de conducir) Si por algun motivo no tienen una de estas formas de identificacion por favor traer la acta de nacimiento, o un documento oficial de la escuela que tenga la fecha de nacimiento de su hijo/a.

2) Si tienen, el numero de seguro social del estudiante. (No ocupan traer fisicamente la tarjeta del seguro social) 

3) Si tienen, alguna tarjeta de seguro medico por favor presentarla el dia de la clinica.

(Ejemplos: Medicaid, Blue Cross BlueShield, o otros seguros medicos comerciales)

Si no puede llenar los documentos necesarios antes del dia de la clinica por favor llegar 15 minutos antes de la hora de su cita para completar los documentos. Tendremos todos los documentos disponibles el dia de la clinica para usted.

 

PLEASE PRINT AND FILL OUT THE REQUIRED FORMS:

1. FORM 1 –COVID-19 Consent and Release Form – Please access INSTRUCTIONS FOR FORM 1 if you have any questions. (Please note: do not check either the Pfizer or the Moderna box on this form until you the day you are vaccinated. Wait until you are told by the pharmacy at the time of your appointment which vaccine you are receiving.)

2. FORM 2 – Texas Immunization Registry Adult Consent Form – Please access INSTRUCTIONS FOR FORM 2  if you have any questions.

3. FORM 3 – Texas Immunization Registry Minor Consent Form – Please access INSTRUCTIONS FOR FORM 3 if you have any questions.

4. FORM 4- Consent For Unaccompanied Minor Coronavirus Vaccination  

 

POR FAVOR IMPRIMA Y LLENE LOS FORMULARIOS REQUERIDOS: 

1. FORMULARIO 1 – COVID-19 FORMULARIO DE ENCENDIDO Y LIBERACION – Por favor consulte FORMULARIO 1 INSTRUCCIONES si tiene alguna pregunta.

2. FORMULARIO 2 – REGISTRO DE INMUNIZACION DE TEXAS PARA ADULTOS – Por favor consulte FORMULARIO 2 INSTRUCCIONES si tiene alguna pregunta.

3. FORMULARIO 3 – REGISTRO DE INMUNIZACION DE TEXAS PARA MENORES DE EDAD – Por favor consulte FORMULARIO 3 INSTRUCCIONES si tiene alguna pregunta.

4. FORMULARIO 4 – CONSENTIMIENTO PARA UN MENOR EN RECIBIR VACUNA SIN ADULTO

The above-referenced forms are the only forms you are required to fill out. The below documents are additional resources:

V-safe Info Sheet

Moderna FAQ Sheet (English)

Moderna FAQ Sheet (Spanish)

Pfizer FAQ Sheet (English)

Pfizer FAQ Sheet (Spanish)

If you would like to release your vaccine records to another party, please access and fill out I MMTRAC Authorization To Release Official Immunization History.

If you wish to extend maintaining your vaccine records by the State of Texas beyond the five-year statutory period, please access and fill out IMMTRAC Disaster Information Retention Consent Form.

The ADDITIONAL RESOURCES documents posted are for informational purposes only. You will be given access to copies at the time of your vaccination.