Please see attached Covid vaccine consent form (below) to print, review and sign – you do not have to wait to sign in person. If you do not have a printer, no worries, we will have some at the clinic for you to complete (it just makes it a faster process if you bring it with you). You will have to fill this out for the second vaccine as well, as this is the only way for me to track who receives the vaccine. As a reminder, please wear a mask.
We get both Moderna and Pfizer vaccines which have different intervals at which you get your second dose. I do not know from week to week which vaccines I am getting except second shots (you will always get the same brand second dose). You will be getting your second vaccine in at exactly that interval, same time, same place, and you do not need to make another online appointment – just show up during the time frame you came for your first visit. You are guaranteed your second vaccine, so do not worry. The sign up is merely so that we do not have too many people coming at once. You will be asked to wait 15 minutes after your vaccine for my nurses to monitor you.
You will see on the consent form we ask for your home address – this is ONLY so that we can input your vaccination into the state registry as I am required to do and there are often duplicates of names/birthdates and we want to be sure we are inputting on the correct patient. It also asks for your mother’s maiden name. The Wisconsin Immunization Registry sometimes requires us to confirm this information to ensure no duplicate entries or so that we are entering your vaccination information on the correct person. Ladies, if you have a maiden name, or a full name you do not go by (ex – Margaret as opposed to Peggy), please put your legal, given name or maiden name on the form as well. Many times, you are still listed under a maiden name or your full, legal given name.
COVID Vaccine Consent Form
(Click on image to download PDF or click here if you’re having trouble)
COVID Vaccine Sign-Up
COVID-19 Vaccination Clinics
NO NEW VACCINES AVAILABLE. CHECK BACK THE WEEK OF MARCH 22, 2021.
Sign Up here
W230S8735 Clark St, Big Bend, WI 53103
Parking lot parking is limited, so that is why we did a sign-up for times. You may park in the lot or next door at the bar parking lot, but please use the sidewalk.
Frequently Asked Questions
YES, we are a legitimate clinic and healthcare organization. My business specializes in ONSITE health – meaning, businesses hire me/my team to come into their business’ establishment and set up onsite clinics INSIDE their company and provide healthcare to their employees. If you Google my company, the main site we are at is located in Brookfield, but we have multiple sites around the state.
YES, the Pfizer vaccine is appropriately stored. Once Pfizer vaccine leaves deep freeze in Kalamazoo Michigan, it comes to me fully frozen. Once it thaws, I have FIVE DAYS to use all of the vaccine. I am required by the state and the Federal Government to have an approved vaccination refrigeration system and I had to sign a contractual agreement with the state that I would keep the vaccine as package directed storage indicates and administer according to the advised state phases.
YES, we have all appropriate life-saving measures on site during vaccinations clinics like EpiPen, ambu bags and oral airways. My staff is never left alone and there is always 2 or more nurses onsite who are all registered nurses with Life Support certifications. If you have a history of severe allergic reaction to vaccinations, you SHOULD NOT come to our clinic to be vaccinated and should go to a hospital setting. Again, I am required by the state as a registered Covid vaccinator to have all of this in place.
Lastly, I am an independently owned and operated healthcare business NOT affiliated with any hospital system. Yes, I had to go through a rigorous application process in order to be a registered Covid vaccinator. Waukesha County Health is in the process of actually putting my information on their website as a community partner to help administer vaccines to the community.