GO Health Pop-up Vaccine Clinic

Thank you for expressing interest in hosting a clinic for your business/organization! Genesee and Orleans County Health Departments will do our best to work with the needs of our community to offer these clinics. As a business owner / organizational leader, we ask that you offer this opportunity to all employees/members within your location(s) and offer flexibility for scheduling needs to allow for vaccination on the day(s) of the clinic.

Please note: all vaccine recipients must complete and pass a screening questionnaire to qualify for a vaccine. Individuals must be at least 18 years of age to receive Moderna or Johnson & Johnson vaccine and 12 years of age to receive Pfizer vaccine. No exceptions. All individuals must be able to commit to a second dose vaccine to receive the first dose. Additionally, all individuals must answer "no" to the following questions on the day of the clinic to be medically eligible to receive the vaccine.

Please refer to this list when inquiring about employee/member interest.

In the last 10 days, have you had a positive COVID-19 test or been told by a healthcare provider or health department to isolate or quarantine at home due to COVID-19 infection or exposure?
Have you had any vaccine in the past 14 days (2 weeks) including a flu shot?
Have you already received a COVID-19 vaccine at another clinic?
Have you been treated with antibody therapy or convalescent plasma for COVID-19 in the past 90 days?

Please complete the information below then wait for a health department employee to reach out to you to further discuss a potential clinic.

Question Title

* 1. Please provide your business/organization contact information:

Point of Contact for scheduling a potential COVID vaccine clinic:

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Point of Contact Email Address

Point of Contact Phone Number

Question Title

* 2. Out of all your employees or organization members***, how many can you confirm would be interested in receiving the vaccine (Moderna, Johnson & Johnson or Pfizer), should the Health Department offer a clinic at your site?

***Please offer to all employees/members and then report the final number

Question Title

* 3. Although we often have access to Moderna, Pfizer, and Johnson & Johnson, we would only be able to schedule one type of clinic. Please check which options would be acceptable for you as a group. We understand this may affect the final number of interested recipients indicated above.

Moderna Clinic (requires return for 2nd dose 4 weeks later)

Pfizer Clinic ( for anyone 12 years and older requires return for 2nd dose 3 weeks later)

Johnson & Johnson (single dose)

Question Title

* 4. Do you have an on-site indoor location that could accommodate at least 20 individuals while all are still socially distanced by at least 6 feet?

Yes

To check upcoming vaccination clinics visit the GO Health Vaccine webpage.

https://bit.ly/GOHealthVaccine