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Cornerstone Care COVID-19 Booster - Washington Pediatrics

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Are you 65 or over?*
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Are you 18 or over and have an underlying medical condition, work in a high-risk setting, or live in a long term care setting?*
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For a full list of qualifying medical conditions, please visit the CDC’s page here: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html(opens in a new tab)

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Did you receive your initial COVID Vaccine at Cornerstone Care?

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County of Residence
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Do you certify that you are at least 18 years old?
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Gender
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Marital Status
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Race
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Cultural Origin
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Language Barrier
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Homeless Status:
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Migrant Worker Status:
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Public Housing
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Veteran Status
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Are you a current Cornerstone Care Patient?
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Are you sick today?
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Have you been diagnosed with COVID-19 within the past 3 months by PCR or antigen testing or are you currently awaiting the results of a COVID test?
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In the past two weeks, have you had contact with anyone who tested positive for COVID-19?
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In the last 10 days, have you had a fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, nausea, vomiting or diarrhea?
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Have you had a severe reaction (such as hives or difficulty breathing) to any previous vaccine?
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Do you have severe allergies to any medications, food, insect bites or a previous history of anaphylactic reaction or have you peen prescribed an EpiPen for any reason?
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Are you actively being treated for any immunocompromising diseases such as cancer, lupus, rheumatoid arthritis or any other autoimmune disease?
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For women, are you pregnant, is there a chance you could become pregnant within the next two months after this vaccine dose, or are you breastfeeding?
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Do you certify that you have answered all screening questions accurately and to the best of your ability?
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