COVID-19 Vaccination Status

COVID-19 client vaccination form

The purpose of this form is to document your COVID-19 vaccination status. If you are not vaccinated, or do not wish to share this information with us, there is no need to submit this form. Proof of vaccination is optional but is required to take advantage of changed masking policies for those with vaccinated status.

First Name *

Last Name *

Phone Number *

Have you received a COVID-19 vaccine?

Which vaccine did you receive?

Pfizer

Moderna

Johnson & Johnson

OtherOther

On which date did you receive your most recent vaccine dose or booster?

Please upload an image of your completed vaccination card or other acceptable vaccine passport document.

Maximum upload size: 52.43MB

Masking Policies

February 18, 2022 12:44 pm

Stage 3 Policy changes

June 7, 2021 10:21 pm

Stage 2: Classes!

September 30, 2020 5:48 pm

COVID-19 Vaccination Status

The Myo Institute

Masking Policies

Stage 3 Policy changes

Stage 2: Classes!

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