COVID-19 Vaccination Registration

After completing this form, you will be redirected to our Patient Portal to complete your registration.
You MUST complete registration in our Patient Portal in order to be on the waiting list for the vaccine.

SEE INSTRUCTIONS BELOW FOR OUR PATIENT PORTAL

  • Click “SEND” above to be redirected to our Patient Portal (You do not need to be a patient)
  • From there, click on “Pre-Register” at the bottom right corner of your screen and complete the form
  • After completing this form, you will be contacted with instructions on receiving your vaccination
  • You Only Need To Complete This Form ONCE