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Dr. Kevin B. Lee
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DeKalb
Henry County
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CHURCH PORTAL
(770) 593-4421 |
2201 Young Road Stone Mountain, GA 30088
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PLAN YOUR VISIT
ABOUT
Church History
Dr. Kevin B. Lee
Our Staff
Employment Information
Berean CC Henry
Berean CC Dekalb
GIVING
New System (PushPay)
Old System
Gwinnett
DeKalb
Henry County
CLASSES
24 Minutes of Prayer
Classes
Small Groups
Masterlife Registration
Spiritual Gifts Assessment
CONNECT
Ministries
Coordinator Hub
Events
We Care Team
SERMONS
CHURCH PORTAL
Ways to Give
Events
Watch Now
COVID Vaccination
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Click the link below to complete a questionnaire for the Gwinnett COVID-19 Vaccination:
Complete Questionnaire
Gwinnett COVID-19 Vaccination Questionnaire
WELCOME!
This form is a preliminary health screening for those who are interested in receiving a vaccination. Please note that this registration is open to the first 100 people who apply. All registrars after the initial 100 will be placed on a waiting list.
Personal Information
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Gwinnett Vaccination Pre-Screening Questions
If your response to any of the below statements are Yes, you are not eligible for vaccination.
1. Have you ever had a life threatening allergic reaction after a dose of any vaccine or injectable medication or any immediate allergic reaction of any severity to a previous COVID-19 vaccine or any of its components (including polysorbate)?
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Select Yes or No
Yes
No
2. Have you had a vaccine within the past 14 days and will NOT receive another vaccine within the next 14 days?
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No
3. Are you currently under isolation (infected with COVID-19), nor under quarantine, (exposed to someone with COVID-19)?
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No
4. Are you currently moderately or severely ill?
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No
5. Have you received monoclonal antibody therapy or convalescent plasma for COVID-19 treatment in the past 90 days?
*
Select Yes or No
Yes
No
6. Do you have a severe (life threatening) allergy to any component of this vaccine as detailed in the Emergency Use Authorization?
*
Select Yes or No
Yes
No
Unfortunately, at this time, we are not able to complete your application for COVID-19 Vaccination Pre-Screening at this site. Please check with your local health department or physician for guidance on receiving COVID-19 vaccinations.
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