COVID-19 Vaccine Information/Scheduling

COVID-19 Vaccine Administration Form

(Form must be completed for all vaccine appointments
and brought to appointment

Parker Pediatrics is pleased to be a provider of the COVID-19 Vaccine to both our patients and families, as well as members of the general public, who are currently eligible to receive the vaccine –  Currently ages 12 and older (must be 12 on day of vaccine administration).

Call the office to check availability and schedule into one of the upcoming clinics.

  • Vaccine Available:  Pfizer 2-Dose Vaccine.  First and second dose must be same manufacturer.
  • Dosing Guidelines:
    • The second dose can be given from 17 days to 6 weeks following the initial dose.
    • For the second dose, please bring your vaccine card to the appointment as well.

For ALL COVID vaccine clinics, you must complete the COVID-19 Vaccine Administration Form-19 Vaccine Administration Form and bring it with you. 

    1. Information is required to be completed on pages 1 and 2.
      • Please use full legal names – NOT nicknames.
    2. Be sure to print the completed form and bring to your vaccine appointment.
    3. Please DO NOT sign the form until the day of your appointment.
      This must be done in front of a witness.

Thank you in advance for your assistance in providing accurate and complete information in order to help us ensure that the information we are required to submit to the State of Colorado will be complete and correct for all individuals receiving vaccines.

Useful Outside Links for Additional Information:

CIIS Public Portal – How to Use the Public Portal to Retrieve Your Immunization Records

CDC – COVID-19 Pfizer Vaccine

Fact Sheet for Recipients and Caregivers

Colorado Department of Health & Environment
Frequently Asked Questions

CDC – Myths and Facts About COVID-19 Vaccines