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San Benito, TX
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COVID-19 vaccination forms

COVID-19 vaccination forms and additional information

Vaccination consent form - English (To be completed)

Vaccination consent form - Spanish (a completar)

Immunization form - English (To be completed)

Immunization form - Spanish (a completar)

Moderna fact sheet - English

Moderna fact sheet - Spanish

V-Safe information sheet - English

V-Safe information sheet - Spanish


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  1. City of San Benito 
    401 N Sam Houston Boulevard
    San Benito, TX 78586

    Phone: 956-361-3800

    Email comments to: 
    Frontdesk@cityofsanbenito.com;
    fbell@cityofsanbenito.com

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