The online sign-ups are completed through a third party online software system called PrepMod. This website is not managed or maintained by Gallatin City-County Health Department, but we do provide feedback and receive updates from them.
PrepMod has stated they do not support Internet Explorer as a web browser. Users may experience issues if they use this browser when they are signing up for online appointments.
PrepMod suggests using Google Chrome or Microsoft Edge for the best experience. We have not heard of issues when users use other web browsers such as Firefox or Safari, but Chrome and Edge are the suggested browsers.
Even if you have health insurance, during the online sign-ups please choose the “No Insurance” option to continue your online sign-up. The COVID-19 vaccine is being offered to the public free of charge.
The Gallatin City-County Health Department is NOT charging you an administrative fee as of today.
We request that you choose “No Insurance” during your online sign-up.
PLEASE NOTE: This is just a preview! You will still be required to answer these questions during your online sign-up.
Is this your first or second COVID-19 vaccination?
Which vaccine brand did you receive the first time?
Are you feeling sick today?
Have you ever received a dose of COVID-19 vaccine? If yes, which vaccine product? Pfizer? Moderna? Another Product?
Have you ever had an allergic reaction to: (This would include a severe allergic reaction [e.g. anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.) A component of the COVID-19 vaccine, including polyethylene glycol (PEG), which is found in some medications, such as laxatives and preparations for colonoscopy procedures Polysorbate A previous dose of COVID-19 vaccine.
Have you ever had an allergic reaction to another vaccine (other than COVID-19 vaccine) or an injectable medication? (This would include a severe allergic reaction [e.g. anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.)
Have you ever had a severe allergic reaction (e.g. anaphylaxis) to something other than a component of COVID-19 vaccine, polysorbate, or any vaccine or injectable medication? This would include food, pet, environmental, or oral medication allergies.
Have you received any vaccine in the last 14 days?
Have you ever had a positive test for COVID-19 or has a doctor ever told you that you had COVID-19?
Have you received passive antibody therapy (monoclonal antibodies or convalescent serum) as treatment for COVID-19?
Do you have a weakened immune system caused by something such as HIV infection or cancer or do you take immunosuppressive drugs or therapies?
Do you have a bleeding disorder or are you taking a blood thinner?
PLEASE NOTE: this is just a PREVIEW of the consent language.
All recipients of the COVID-19 vaccine must provide their consent for services. There are two boxes you’ll need to check during your online sign-ups.
“By signing this form, I am requesting vaccination services for myself and/or the persons identified, of whom I am authorized to sign. A copy of the appropriate Centers for Disease Control and Prevention Vaccine Information Statement(s) has been provided. I have read the information about the disease(s) and the vaccine(s) listed. I believe that I understand the benefits and risks of the vaccine(s) cited and ask that the vaccine(s) listed be given to me or to the person named (for whom I am authorized to make this request).”
“I authorize this health care provider and a public health agency to collect and enter immunization records into the Department of Public Health and Human Services’ Immunization Information System (IIS). The IIS is a confidential, computer system that contains immunization records. I understand that information in the registry may be released to a public health agency as well as my or my child’s health care providers to assist in medical care and treatment. In addition, information may be released to child care facilities or schools in order to comply with immunization requirements. I understand that I can revoke this authorization and have my or my child’s record removed at any time by contacting the State of Montana Immunization Program.”
Please be sure your contact information is correct! It is VERY important to have your accurate contact information. This will be used to update any details for your vaccine appointment as well as for scheduling your second dose if needed.