COVID vaccine

Graham Family Dental is preparing to become a distribution center for the COVID vaccine as a service to our community. To receive the COVID vaccine, please following these steps:

  1. Fill out the survey. Once we receive your submission our team will review your answers and reach out to you within the next 2 business days to let you know if you qualify.
  2. Schedule an appointment. If you qualify to receive the vaccine we will work with you to set up an appointment.
  3. Complete paperwork. You can download and fill out the required forms from our website. Or you can arrive a few minutes ahead of your appointment and fill out the forms in person.

 

    Eligibility Survey


    Name *

    Date of Birth*

    Email *

    Phone *

    Are you a healthcare worker? For eg. physician, nurse, respiratory therapist, EMS, support staff, clinical staff providing laboratory, pharmacy, diagnostic testing etc.

    Are you a long term care staff working with vulnerable patients? For eg. nursing homes, assisted livings, support living centers, nurses, food staff etc.

    Are you a resident of a long-term care facility?

    Are you a last care responder? For eg. Embalmer, funeral home staff, medical examiners etc.

    Are you 65 years of age and older?

    Are you 16 years of age and older with at least one of the following medical conditions that would put you at an increased risk of severe illness from the virus that causes COVID-19, such as but not limited to:

    • Cancer
    • Chronic Kidney Disease
    • COPD
    • Heart conditions such as heart failure
    • Coronary artery disease or cardiomyopathies
    • Solid organ transplantation
    • Obesity and severe obesity (body mass index of 30k/m or higher
    • Pregnancy
    • Sickle cell disease
    • Type 2 diabetes mellitus 

    Mixed to limited evidence such as but not limited to:

    • Smoking
    • Asthma
    • Hypertension
    • Bone marrow transplant
    • HIV
    • Liver disease
    • Neurological conditions
    • Chronic lung disease
    • Thalassemia
    • Type 1 diabetes

    Required Paperwork

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