- 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.