Hindu Temple of KC / Appointments for Covid Vaccination
Email (Must have for appointment confirmation)
Please read carefully
Filling this form to request an appointment is not a guarantee you will get one. We will only forward information to Medical facility and they will reach out to you if a slot is available based on criteria.
Only one request per person. Multiple requests for the same person will be rejected.
If you had already submitted a request, no need for another one.
If you want to update details submitted, check your acknowledgement email for steps.
Date of Birth (Must be 65 or older)
If you are below 65 years, your information will not be processed.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Hindu Temple & Cultural Center of Kansas City.