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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.
Drive Through

Please click the registration form below to schedule a drive through appointment at the hospital lobby pavilion.

COVID 19 Vaccination Screening & Registration Form

The Governor has opened up vaccines to anyone over the age of 18 as of April 5th. The form below serves as a screening and registration form for anyone in that age bracket. Please complete this form to register for a drive through appointment at the hospital and a logistics coordinator will confirm a day and time for you to join us at the drive through Vaccination Station at the front lobby pavilion.

Section 2 - Insurance

Section 3: COVID19 SCREENING

PLEASE CHECK YES OR NO FOR EACH QUESTION BELOW. ARE YOU OR HAVE YOU EVER...

Click YES to give consent and click SUBMIT to finish.

Section 4: Certification & Authorization Statement


Formulario de registro y detección de vacunación COVID 19

El gobernador ha abierto las vacunas a cualquier persona mayor de 18 años a partir del 5 de abril. El siguiente formulario sirve como formulario de evaluación y registro para cualquier persona de ese grupo de edad. Complete este formulario para registrarse para una cita y un coordinador de logística confirmará el día y la hora para que se una a nosotros en el recorrido a través de la estación de vacunación.

Sección 2 - Seguro

Sección 3: EXAMEN COVID19

POR FAVOR MARQUE SÍ O NO PARA CADA PREGUNTA A CONTINUACIÓN. ES USTED O HA USTED alguna vez ...

Haga clic en SÍ para dar su consentimiento y haga clic en ENVIAR para finalizar.

Sección 4: Declaración de certificación y autorización

Employer Sponsored

Please click the registration form below to schedule a mobile vaccination appointment at an employer sponsored event.

COVID 19 Vaccination Mobile Screening & Registration

Your employer has provided you the opportunity to receive the vaccine at work. The form below serves as a screening and registration form for anyone who is interested in booking a mobile vaccination appointment. Requirements: over the age of 18, a copy of an insurance card (if you have insurance), and a picture ID verifying you are a Florida Resident.

Section 2 - Insurance

Section 3: COVID19 SCREENING

PLEASE CHECK YES OR NO FOR EACH QUESTION BELOW. ARE YOU OR HAVE YOU EVER...

Click YES to give consent and click SUBMIT to finish.

Section 4: Certification & Authorization Statement

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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