To ensure a quick experience, print and fill out this form and bring it to your appointment. Those who cannot print this form and fill it out ahead of time will be able to fill it out at the clinic.
In accordance with the ADA, Missoula County will provide reasonable accommodation for individuals with disabilities. To request an accommodation during your appointment, call 406-258-INFO (4636).
Minor Appointment Paperwork
A parent or guardian should print and fill out the form above for their child in addition to the following forms if applicable. Parents or guardians must also read this Pfizer fact sheet (for 12 and up) or this Pfizer fact sheet (for ages 5-11).
Sixteen and 17-year-olds are eligible for unaccompanied minor appointments. They must bring this unaccompanied minor document, filled out by a parent/guardian, in addition to the documents above.
Parents and guardians can send their child to an appointment with an authorized adult, such as a babysitter or grandparent, if they fill out this third party authorization form.
Homebound Vaccination Request
Missoula County Health Department offers an option for our homebound residents to receive the COVID-19 vaccine from the comfort of their own home. Please click here to be put on our Homebound Vaccination List or call us at (406) 258-INFO (4636).
Replacement Vaccine Cards
The Missoula City-County Health Department can help individuals replace their vaccine card if they opted into Montana's IMMTRAX vaccination record system when they signed up to get vaccinated. Our staff can assist you in finding your vaccine record and getting you a new card if you walk into the COVID-19 vaccine clinic at the Southgate Mall during regular business hours.
For More Information on Vaccines
Please visit the US Centers for Disease Control and Prevention's website for more information on the studies, research, safety and potential side effects of the COVID-19 vaccines.
Getting to the Southgate Mall Clinic
For those using public transportation, Mountain Line routes 1, 2, 6, 7, and 8 stop at the Southgate Mall.
The vaccine clinic is in the former Lucky's Market on the southeast side of the mall facing Brooks St.
Monday - 3 p.m. to 7 p.m.
Tuesday - 9 a.m. to 4 p.m.
Wednesday - 9 a.m. to 4 p.m.
Thursday - 9 a.m. to 4 p.m.
Friday - 9 a.m. to 1 p.m.
Saturday - 10 a.m. to 2 p.m.
Sunday - 10 a.m. to 2 p.m.