Covid-19 Vaccine Interest Form

Please fill out the following form to schedule an appointment to receive the COVID-19 vaccine. By completing this form, you are not obligated to receive the COVID-19 vaccine from iResearch Atlanta and may cancel your appointment at any time. If you would like to learn more about the vaccine go to https://www.fda.gov/media/144638/download.

Please select the vaccine dose you will be receiving. You will be required to bring your vaccination record with you if you are getting a 2nd dose or booster. *

Seeking 1st dose of vaccine for 5 years of age and older Seeking 2nd dose of vaccine and 5 years of age and older Seeking 1st dose of vaccine for 6 months of age to 4 years old Seeking 2nd dose of vaccine for 6 months of age to 4 years old Seeking 3rd dose of vaccine (booster) and 12 years of age and older

Thank you for your interest in receiving the COVID-19 vaccine in an effort to help prevent the spread. At this time, you have not registered under an eligible group to receive the vaccine. Please return to our website at a later date once you qualify under the State of Georgia COVID-19 vaccine eligibility groups. In the meantime, please continue to follow the CDC’s guidelines for COVID-19 safety. We look forward to serving you soon!

Covid-19 Vaccine Scheduling