Covid-19 Vaccine Registration

SIGN UP BELOW TO BE ADDED TO OUR WAITING LIST.

 

WE WILL BE PRIORITIZING PATIENTS ACCORDING TO MDHHS RECOMMENDATIONS.

THIS PRE-REGISTRATION FORM IS ONLY FOR PEOPLE WHO HAVE NOT RECEIVED THE FIRST DOSE OF A COVID-19 VACCINE. IF YOU HAVE ALREADY RECEIVED A FIRST DOSE, PLEASE CONTACT YOUR PROVIDERS OFFICE.

Are you a healthcare provider, healthcare personnel, or do you work in a healthcare facility?
Except for healthcare workers, are you an essential worker? Examples: education, food and agriculture, first responders, grocery store workers, correction officers, transportation
Do you have a medical condition that puts you at an increased risk of severe disease from COVID-19? Examples: chronic heart, lung, or kidney disease, diabetes, obesity, pregnancy, cancer, sickle cell disease, a smoker, you are a transplant patient, other compromised immune system condition.