COVID-19 Vaccine Registration Assistance
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Are you eligible for the current phase of COVID vaccine rollout in Texas? Eligible Categories: 1A for healthcare workers, 1B for age 65+ or underlying conditions, 1C for ages 50-64, and educators.
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Name
Address
Email address
Phone number
Date of Birth
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/
DD
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YYYY
How far are you willing/able to travel?
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Please list any days/times that you are unable to attend a vaccine appointment.
Is there anything else we should know? (vaccine preference, 1st or 2nd dose, etc)
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