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COVID-19 Vaccines are currently available by AMC Clinic in partnership with the Guam Department of Public Health.

Who pays for my COVID-19 vaccine?

Your COVID-19 vaccine is no cost or "zero out of pocket" for you.

Are you feeling sick today?

There is no evidence that acute illness reduces vaccine efficacy or increases vaccine adverse events. However, as a precaution with moderate or severe acute illness, all vaccines should be delayed until the illness has improved. Mild illnesses (e.g., upper respiratory infections, diarrhea) are NOT contraindications to vaccination. Do not withhold vaccination if a person is taking antibiotics.

Vaccination of persons with current SARS-CoV-2 infection should be deferred until the infection has been resolved.

Why get the COVID-19 vaccine?

The Centers for Disease Control and Prevention (CDC) recommends everyone over 16 years of age and older get vaccinated.

Prevaccination Questionnaire

The following questions will help us determine if there is any reason you should not get the COVID-19 vaccine today.

If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means additional questions may be asked.

If a question is not clear, please check in with your community navigator at AMC.

Are you feeling sick today?
Have you ever received a dose of COVID-19 vaccine?
If yes, which vaccine product did you receive?
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.)

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 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?
Are you pregnant or breastfeeding?

Your Demographic Information

What is your sex and race?

Why are we asking for this?

Your Contact Details

Your Address Details

Your Insurance Details

Testing in Guam is primarily paid for by health insurance. Do you have health insurance?*

Why are we asking for this information?

I attest that I don't have employer-sponsered or individual healthcare coverage, Medicare, Medicaid and that no other payer will reimburse for COVID-19 testing from AMC.

Consent Form

CONSENT FOR SERVICES:

I have read the attached mRNA COVID-19 vaccine fact sheet. I understand the expected benefits and possible risks and side effects of the vaccines. I have voluntarily chosen to receive the vaccination and consent to the administration. I understand the possible risks to myself if I am not vaccinated. I will alert my provider of any medical conditions which may adversely affect my personal health or the effectiveness of the vaccine. I have had the opportunity to have my questions answered by American Medical Center staff.

I authorize American Medical Center staff to administer the mRNA COVID-19 vaccine to myself.

I understand that AMC may be required to or may voluntarily disclose my health information to the physician responsible for this protocol of specific health information of people vaccinated at AMC (if applicable), my Primary Care Physician (if I have one), my insurance plan, health systems and hospitals, and/or state or federal registries, for purposes of treatment, payment or other health care operations (such as administration or quality assurance).

LOCATION

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Pick a date

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Please Confirm your info and book your appointment

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Thank you for choosing AMC Clinic

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Please remember to bring your ID and your confirmation number to your appointment