Horizon Health Care COVID-19 Vaccine Waitlist

After you complete the form below, you will be contacted by the clinic of your choice to finalize vaccination appointment scheduling. This may take up to 3-5 days.

Covid-19 Waitlist

Name*
First Middle Last
Sex*
- Female
- Male
- Unknown
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Priority Group*
Preferred Location To Receive Vaccine*
Please do not register more than one time, additional registrations do not change your position on the list. If you need to make a location change you will be able to do so once you are contacted by our scheduling teams.
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Horizon Health Care COVID-19 Vaccine Waitlist

Covid-19 Waitlist

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