COVID Vaccine Request Form

Vaccine Request Form

Please complete the following fields to request appointment for COVID-19 vaccine. Once this form is completed you will be contacted when an appointment is available. Due to limited supply, wait times may be extended. Availability is based upon state eligibility requirements. Please do not submit duplicate registration requests as this may delay processing of your request.

Calls and texts for scheduling should go to 859-745-4445.

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COVID Vaccine Request Form

Vaccine Request Form