Clemmons
3163 Gammon Ln
Clemmons, NC 27012
(336) 310-5571
Visits cannot be scheduled online right now.
At Clemmons, you can skip the wait. Just choose the time
you'd like to come in, and we'll hold your spot.
Please select an appointment type and provider to see available times
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Visit Time is required.
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Patient First Name
Patient Last Name
Email
Cell Phone Number
Please do NOT use this system if you are having a life threatening medical emergency. Call 911.
Staff Notes
Which Shot
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First Dose
Second Dose
Third Dose
Certification of Membership in Priority Vaccination Group
I understand that vaccine supply is currently limited and, therefore, subject to strict prioritization in accordance with Centers for Disease Control. With that understanding, I hereby certify under penalty of law that you belong to one of the group(s) listed below:
ANYONE age 12 or above
I have read the Priority Vaccination Group above and attest that I am eligible at this time for the COVID-19 vaccine.
IMPORTANT INFO FOR VACCINE VISITS
Please do not save a spot if any of the following CDC contraindications apply, as we will not be able to administer a vaccine during your visit:
Current illness
COVID diagnosis in the last 10 days
COVID antibody treatment in the last 90 days
Any vaccination in the last 14 days, including the flu shot
Severe allergic reaction to a prior COVID-19 vaccine or its components such as polyethylene glycol
Remote/Staff Registration
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RRA working on chart
Center staff working on chart
Missing Minor Consent
RR incomplete
COR
Missing Demographics
****No card capture/upload
RRA Agent Complete
GH RR Complete
We'll send you a text message when it's time to show up.
minutes before your visit
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