COVID-19 Vaccination Registration - Administered By Baptist Medical Group  
First Baptist Church-Broad is now an equipped facility to administer the COVID-19 Vaccine! We are excited to be able to offer this pivotal health service to our community! The vaccine will be administered by qualified healthcare professionals of the Baptist Medical Group (BMG). Below are the criteria and instructions to receive the COVID-19 vaccine. Please read the instructions in their entirety.

1. Recipient MUST be above 16 years of age, have any health conditions, work any job, provide any healthcare services, and also includes spouses
2. This form must be completed in its entirety - a scheduling representative from BMG will contact you with your appointment time

Once you have received your appointment time, please adhere to the following:
1. Please wear your mask and follow social distancing protocol
2. Please bring your ID and insurance card
3. Enter through the Grand Lobby entrance facing Sam Cooper Blvd

The process includes check-in, vaccination, and a 15 minute observation period to ensure your safety. Please plan to wait for those 15 minutes, as it is necessary for the process. During this observation period, you will view an informational video informing you of the vaccine!

If you have any questions, please contact the church at 901-323-2429.

***In the event that you must cancel your appointment, we ask that you give us a 30-60 minutes advance notice. You should also contact BMG to reschedule your vaccination appointment.  

Sign in to Google to save your progress. Learn more
Name (First, Last) *
Phone Number (Including Area Code) *
Email Address *
What day of the week is good for you? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy