Second Visit Patient Forms (MDR)

Was your initial COVID-19 vaccine administered at the Tooele County Health Department? *
What was the date of your original vaccine? *

Month Day Year
Date
All of our appointments are currently full. Please check back later.
Currently we are only providing the second dose of the COVID-19 vaccine to those that had their initial at the Tooele Health Department.

YOUR SECOND VACCINE MUST BE SCHEDULED FOR 28 DAYS OR MORE, AFTER YOUR INITIAL VACCINE. IF YOU SCHEDULE FOR A DATE EARLIER THAN 28 DAYS, YOU WILL HAVE TO RESCHEDULE. PLEASE REFER TO THE DATE ON YOUR CDC VACCINATION RECORD CARD TO ENSURE YOU ARE FOLLOWING THESE GUIDELINES.

Appointment *
Is the date selected AT LEAST 28 days after your initial dose? *
Date

Month Day Year
Date
Please select a day that is 28 Days after your initial dose, and re-answer the question above.
Should be Empty: