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COVID-19 vaccine patient forms and information
COVID-19 vaccine patient forms and information

COVID-19 vaccine patient forms and information

Thank you for selecting Mount Nittany Health to administer your COVID-19 vaccine.

Please prepare for your vaccine clinic appointment by:

  • Reviewing, printing and signing your vaccination agreement form.
  • You will need to bring your signed vaccination agreement form with you to your appointment.
  • You will need to bring proof of Pennsylvania residency or employment, such as:
    • Pennsylvania driver’s license or Pennsylvania identification card
    • Utility bill with your name and address
    • Employer identification or badge
    • Business card

Note: There is no cost to receive the COVID-19 vaccine.

Required patient forms

​Note: You should not get the COVID-19 vaccine if you have received any other vaccines in the last 14 days.

​On the day of your appointment

  • Please report to the Mount Nittany Medical Center Galen and Nancy Dreibelbis Auditorium or the Lance and Ellen Shaner Cancer Pavilion. Both are located at the rear of the Medical Center. 
  • Please park in the reserved parking spaces in lot D at the rear of the Medical Center. View a map here.
  • Plan to arrive 15 minutes prior to your appointment time to check in and turn in your vaccination agreement form and proof of residency or employment in Pennsylvania.
  • Note: At check-in, you will be given your vaccine card and your reminder card for your second prescheduled vaccine appointment.
  • Plan for a 15-minute observation period after you have received your shot. ​

If you feel very sick or are experiencing any COVID-like or flu-like symptoms, do not come to your vaccine appointment. Please notify us by calling 814.231.7000.

​Special reminders

  • ​You are required to wear a mask to the vaccine site. If you will not wear a mask, then you will not be permitted to enter the site and will lose your vaccine appointment slot.
  • For your safety and the safety of others, do not bring any children or other visitors with you on the day of your vaccine. One caregiver may accompany you, if needed.
  • It is important that you receive both doses of the vaccine in order for it to be the most effective. 
  • Please keep your vaccine appointment. If you do not arrive for your scheduled appointment time, your slot may be offered to another patient. 

Information about your second dose

  • When you schedule your first appointment for the COVID-19 vaccine using the online self-scheduling tool, you will automatically be assigned a second dose appointment time 21 days after your first dose. This time cannot be changed.
  • You will receive a second appointment reminder card at your appointment for your first COVID-19 vaccine.
  • It is important that you receive both doses of the vaccine for it to be most effective. Please keep your vaccine appointment.

Updated recommendation from the Centers for Disease Control and Prevention (CDC) regarding the second dose of the COVID-19 vaccine

The CDC has updated its recommendation regarding receiving the second dose of the COVID-19 vaccine. If you have experienced an immediate allergic reaction within four hours of receiving the first dose of the vaccine, the CDC recommends that you not receive the second dose. Immediate allergic reactions include the following:

  • Feeling of impending doom
  • Skin symptoms present in ~90 percent of people with anaphylaxis
  • Severe itching of skin
  • Hives
  • Flushing
  • Swelling in the face
  • Confusion or disorientation
  • Severe dizziness or lightheadedness
  • Profound weakness
  • Loss of consciousness
  • Shortness of breath or difficulty breathing
  • Hypoxia
  • Severe hypotension
  • Tachycardia
  • Nausea or vomiting accompanied by abdominal cramps and diarrhea

Based on the CDC’s recommendation, Mount Nittany Health will not be able to give a second dose to any patient that experienced an immediate allergic reaction within four hours of receiving the first dose of the COVID-19 vaccine. Please contact your doctor immediately if you experience any moderate or severe reactions or if you have any concerns.

Vaccine adverse event reporting system.

Note: Your second vaccine appointment will be given in the same location.