Covid-19 Vaccination Registration Form

Lockhart Family Medicine

Please correct the errors described below.


1. How much does the COVID-19 vaccine cost?

No person will have to pay any out-of-pocket cost to receive the COVID-19 vaccine.

2. What if I'm uninsured?

We will still provide the vaccine at no charge to you.

3. I thought the vaccine was free. Why is my insurance being billed?

The vaccine is provided to all patients at no cost to them. However, we will bill your insurance carrier for the cost to administer the vaccine, as the goverment has put measures in place that allow healthcare providers to be reimbursed for their efforts to vaccinate the American people. You should not receive a bill for this - it is purely administrative with your carrier.

4. What should I do if I receive a bill?

If you receive a bill for the COVID-19 vaccine in error, please do not pay it.

Contact us directly at 512-376-5247 for assistance.

5. How will I get the second dose that is required?

We will schedule your second dose at the conclusion of your 1st dose appointment. We will provide you with your vaccine card and details of your second dose appointment.

Your information will be encrypted.