WEST PALM BEACH

Covid-19 Vaccine Registration

West Palm: 1233 45th Street Suite B4, West Palm Beach, FL 33407

Complete this form if you are 40-years old or older and would like to receive the Johnson & Johnson COVID-19 Vaccine administered by the Florida Department of Health. Only those who are 40-years or older are eligible to receive the vaccine at this administration site.

Ranpli fòm sa a si ou gen 65 an oswa plis epi ou ta renmen resevwa vaksen Johnson & Johnson COVID-19 ke Depatman Sante Florid pral administre nan. Se sèlman moun ki gen 40 an oswa plis ki kalifye pou resevwa vaksen an nan sit administrasyon sa a.

Complete este formulario si tiene 40 años o más y desea recibir la vacuna Johnson & Johnsonh COVID-19 administrada por el Departamento de Salud de Florida. Solo aquellos que tengan 40 años o más son elegibles para recibir la vacuna en este sitio de administración.

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  • Thank you for completing this form. Please plan to wait patiently when you arrive. Further information regarding your health will be obtained by the Department of Health. Please bring at least one form of identification.

    Mèsi pou ranpli fòm sa a. Tanpri planifye pou ret tann avèk pasyans lè ou rive. Depatman Sante pral mande ou plis enfòmasyon konsènan sante ou. Tanpri pote omwen yon fòm idantifikasyon.

    Gracias por completar este formulario. Por favor, planee esperar pacientemente cuando llegue. Más información sobre su salud será obtenida por el Departamento de Salud. Por favor, traiga al menos una forma de identificación.

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Primary Medical Care Center for Seniors applies individualized and perfected medical treatments where they’re most needed! Every senior we take in is a person with individualized needs and wants, and our physicians are deeply aware of that.

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