If you would like to join the waiting list for an appointment at our vaccination clinic, please complete the form below. We will contact you directly when we have an appointment available.
Completing this form is not a guarantee of an appointment. We have a limited supply of vaccine. Information about additional vaccination locations is available on the ADPH website.
*Essential workers (1B) include firefighters, police, teachers and education staff, daycare workers, food and agricultural workers, manufacturing workers, U.S. postal service employees, judiciary, public transit workers, grocery store workers and clergy/ministers.
*Essential workers (1C) include transportation and logistics, waste and wastewater, food service, shelter and housing (e.g. construction), finance (e.g. bank tellers), information technology and communication, energy, legal, media, and public safety (e.g. engineers).
We will contact you by phone when we have an appointment available. Completing this form is NOT a guarantee that you will receive an appointment as we have a limited supply of vaccine. If you are available on short notice to fill in gaps in our schedule, please indicate that below.