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COVID-19 Vaccine Registration Form

  1. REGISTRATION GROUP

    Registration is currently open for ALL GROUPS (Moderna-18 years and older; Pfizer-16 years and older).

  2. Have you already received the first COVID-19 Vaccine dose?*

  3. Have you tested positive for COVID within the last 90 days AND treated symptoms with monoclonal antibodies or convalescent plasma?*

    If unsure, please contact your Primary Care Provider

  4. Are you currently in quarantine or awaiting COVID test results?*

  5. Have you received an immunization within the last 14 days?*

    Based on CDC guidelines, vaccines cannot be given within 14 days of each other.

  6. Please choose your age range.*

  7. Congratulations! You qualify to receive the COVID Vaccine.*

    YOU'RE NOT DONE YET! Click SUBMIT at the bottom to proceed to SignUpGenius and book your appointment. You will need your basic demographic information such as name, date of birth, contact number and email address. If you do not have an email address or are unable to complete the appointment process, please contact us at (252) 636-6693.

  8. PLEASE CONTACT US TO SCHEDULE YOUR SECOND DOSE

  9. PLEASE TRY AGAIN LATER

    Unfortunately we cannot register you at this time due to requirements or appointment type availability.

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