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Moderna COVID-19 Vaccine

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What do I need to bring and prepare for my Moderna COVID-19 vaccine appointment?

  • You must complete the NYS Eligibility Form to be vaccinated. You must show completion of this form when you arrive for your appointment. Once you complete the form online, you can print out the form from your Internet browser or take a screenshot of it on your mobile device.
  • Read and complete the COVID-19 vaccine consent form. Bring the completed and signed printed form with you on the day of your appointment.
  • Review the Patient Fact Sheet for the Moderna vaccine.
  • Bring proof of eligibility to your appointment. This may include an employee ID card, a letter from an employer or affiliated organization, or a pay stub, depending on the specific priority status. If you are eligible because of your age, bring a government-issued ID that includes your date of birth (like a Driver’s License or passport) and proof of residence in New York, such as ID, landlord statement, or lease. 
  • If you are enrolled in a Medicare or a Medicare Managed Care plan, please have your Federal Medicare ID number found on your RED, WHITE and BLUE Medicare Card available at your COVID-19 Vaccine/Booster visit. The COVID-19 vaccine is free to you as it is covered by the state, however administration of this vaccine must be submitted directly to Medicare. If you do not have your original Medicare Red, White and Blue card, our offices can look up this number for you with your Social Security Number.

In addition to the steps above, please enroll in v-safe, a CDC smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination. Through v-safe, you can quickly tell the CDC if you have any side effects after getting the COVID-19 vaccine. Depending on your answers, someone from CDC may call to check on you. And v-safe will remind you to get your second COVID-19 vaccine dose at the right time.


COVID-19 Vaccine FAQ

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