COVID-19 Vaccine

This form should not be used to make an appointment to receive the COVID-19 vaccine.
Learn how to make a COVID-19 vaccine appointment →

Make an in-person or virtual appointment by filling out the form below or calling 888‑4GW‑DOCS.

A representative will contact you within one business day to set up your appointment. If this is an emergency, call 9-1-1 or go to your nearest ER.

NOTE: With this form, you are submitting a request for appointment. A representative will contact you once an appointment has been secured or, if necessary, to discuss alternative options.

Appointment Information
Insurance Information
Contact Information
E.g. willing to see a different provider in order to match any preferred availability