COVID-19 Vaccine Wait List

COVID-19 Vaccine Wait List
We will contact you via email once we have COVID-19 vaccine available for you. Please submit a form for each eligible person under Phase 1a+ that needs to be vaccinated. While we are awaiting more allocation of the vaccine from DPH, you may want to check with the County Health Department to see if they can vaccinate you sooner.
Please complete all information below:
Name

Mr./Mrs./Ms. First Name Last Name
Age
E-mail
Phone
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please select one of the options below to confirm your eligibility to be vaccinated under Phase 1a in Georgia.

Healthcare workers including nurses, physicians, EMS, lab technicians, etc. Long-term care facilities (LTCF) staff and residents Adults 65+ and their caregivers Law Enforcement, fire personnel (including volunteer fire departments), dispatchers, 9-1-1 operators. None of the above (if you select this option you do not qualify right now to get the vaccine)
Should be Empty: