- A copy of your insurance cards (front and back), including a copy of the front and back of you Medicare Card (even if you have an advantage plan).
- A separate page with a copy of your identification/driver’s license (front and back)
- A completed information sheet – Click here for a copy of the information sheet
- A consent form – Click here for a copy of the consent form
There is no out-of-pocket expense even for those who do not have insurance coverage. Please read the Moderna and Pfizer vaccination information sheets and plan on a 15-30 minute observation period after you receive your vaccination. If you have concerns about receiving the vaccine due to a health condition or other medical reason, please discuss this with your Medical Provider.
For those of you returning for your second dose of the Covid-19 vaccination through Lower Umpqua Hospital District, please bring your vaccination card that you received at your first appointment and a completed consent form. If your insurance information or personal information has changed, you will also need to bring a copy of your updated insurance cards (front and back) and an updated information sheet. Please read the Moderna and Pfizer vaccination information sheets and plan on a 15-30 minute observation period after you receive your vaccination.
- Click here for a copy of the Moderna vaccination information sheet
- Click here for a copy of the Pfizer vaccination information sheet
- Click here for information about VSAFE reporting
- To read our COVID-19 Vaccine Updates, click on each date listed below.
- April 19, 2021 Update
- Frequently Asked Questions – Oregon Health Authority 4/15/21
- April 13, 2021 Update
- April 5, 2021 Update
- April 2, 2021 Message from Drs. Audrey and Greg Shank
- March 30, 2021 Update
- March 26, 2021 Update
- March 25, 2021 Update
- March 24, 2021 Update
- March 23, 2021 Update
- March 22, 2021 Update
- March 19, 2021 Update
- March 18, 2021 Update
- March 17, 2021 Update
- March 16, 2021 Update
- March 15, 2021 Update
- March 12, 2021 Update
- March 11, 2021 Udpate
- March 10, 2021 Letter from Dr. Jason Sargent, Chief of Staff
- March 9, 2021 Update
- March 8, 2021 Update
- March 5, 2021 Update
- March 4, 2021 Update