RESPONSE REQUIRED - COVID-19 Booster Information/Update

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* 1. Full Name:

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* 2. Have you received a COVID-19 booster?

Yes

No

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* 3. If you have received your booster, have you provided information to HR?

Yes

No

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* 4. If not, we encourage you to attend our clinics, or schedule your own booster. Select ONE of the following options:

I will get my booster on Tuesday, January 4th at Valley on 42nd between 1:30pm and 3:30pm

I will get my booster on Tuesday, January 11th at Valley on Columbia between 1:30pm and 3:30pm

The above dates and times do not work for me. I will schedule my booster for a different day/time.

I do not plan on getting a booster shot