COVID-19 Vaccine Request Form
• COVID-19 Immunization Screening and Consent Form
• To receive the COVID-19 Vaccine you must fill out the required form below
• Please note that completing this request form does not guarantee you will receive the vaccine.
• Upon submission, if qualified, a member of the staff at Roadway will contact you to schedule an appointment.
• Please read the PA Department of Health Guidelines on Phases of Vaccine Distribution.
COVID Related Information
• CDC COVID Vaccination Information
• PA Department of Health COVID-19 Dashboard
• PA Department of Health COVID-19 Vaccine Information
• PA Department of Health PHASE Guidelines
• Register for V-Safe
• When Vaccine is limited who gets vaccinated first?
• FAQs about the COVID-19 Vaccine
• CDC COVID Vaccination Tracking Map
• CDC Advisory Committee on Immunization Practices (ACIP)
It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu. Flu activity most commonly peaks in the United States between December and February. CDC recommends yearly flu vaccines for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.
Why Vaccinations Are Important
In the U.S., vaccines have greatly reduced or eliminated many infectious diseases that once routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines. In about the same time it takes you to pick up a prescription, you can get your next immunization.
At Risk For Serious Disease
Every year thousands of adults in the U.S. still suffer serious illness, are hospitalized, and even die due to disease for which vaccines are available. Even if you were fully vaccinated as a child, the protection from some vaccines you received can wear off. You may also be at risk for other disease due to your job, lifestyle, travel, or health conditions.
Protect Yourself And Your Loved Ones
Vaccines can lower your chance of getting certain diseases. Vaccines work with the body's natural defenses to safely develop immunity to disease and lower your chances of getting certain diseases and suffering from their complications.
Vaccinations Are Safe
Vaccines are tested and monitored. Vaccines go through years of testing before being licensed by the Food and Drug Administration (FDA). Both the CDC and FDA continue to monitor vaccines for safety after they are licensed.