Covid 19 Vaccination Request Form (Phase 1 )
Internal Medicine Associates of Houston has been designated as an approved Covid 19 vaccine site in Texas. Vaccination is open to the community. Vaccines have been allocated to us based on our practice size. Priority will be given to established patients.

If you would like to get vaccinated, please fill out this form. It helps with prioritization
Email address *
Name (First and Last) *
Age *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy