1. Enter your contact information, choose how you would like to be contacted and submit the form.
2. When it is your time to schedule your vaccine appointment, based on ODH guidelines and vaccine availability, you will be contacted via the method you chose on the pre-registration form and be provided a special phone number to call to schedule your vaccine.
If you do not have an email, you can easily create one with Microsoft or Google.
You must be in one of the above groups and have a scheduled appointment with us to receive the COVID-19 vaccine.
* = required