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  1. Please review the latest updates and vaccination priorities and parameters at mcmh.us/covid.
  2. Please complete the REGISTRATION FORM first.
  3. If you check one or more of the vulnerable conditions, please complete the SCREENING FORM second.
  4. A logistics coordinator will get back to you to validate your condition and collect supporting documentation for the clinical team.
  5. Once you qualify to receive the vaccine a logistics coordinator will CONFIRM your appointment.
  6. You MUST have an appointment to receive a vaccine and all supporting documentation must be provided prior to vaccination.  An upload link is provided for your convenience or you can bring a printed copy with you to your appointment.
  7. If you did not select one or more qualifying conditions you will be added to the waiting list and our team will contact you as the Governor continues to open the vaccine up to different demographic groups.
COVID Registration

COVID 19 Registration for U65 Population

We received our second shipment of first dose vaccine. This phase is specifically for ages 18 to 64 with specific at-risk conditions. Please go to mcmh.us/blog for additional details.


Please complete this form as a first step in qualifying to get the Vaccine. A logistics coordinator will get back to you to process the remaining paperwork, validate your at-risk condition, and confirm your appointment.


Click YES to Give Consent and click SUBMIT to finish.


COVID Screening

COVID 19 Vaccination Screening Form

We received our second shipment of first vaccine doses. This phase is designed to serve ages 18 to 64 with specific at-risk conditions. Once you complete the REGISTRATION FORM, you need to complete this VACCINATION SCREENING form. Once both forms are complete and a logistics coordinator validates your condition, you are ready for your scheduled vaccination appointment.
If you did not fill out the REGISTRATION FORM, please go to http://www.mcmh.us/forms and click REGISTER to complete the form as a first step in getting the Vaccine. A logistics coordinator will get back to you to conduct the screening process, validate your at-risk condition, and confirm your appointment.

Section 2 - Insurance

Section 3: COVID19 SCREENING

PLEASE CHECK YES OR NO FOR EACH QUESTION

Click YES to give consent, Type your full name, and click SUBMIT to finish.

Section 4: Certification & Authorization Statement

DO NOT WRITE BELOW THIS LINE


Contact Us

We're not around right now. But you can send us an email and we'll get back to you, asap. You can also send us a message through our Facebook page. Please do not include personal health information in your communications through social media.

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