COVID-19 Vaccine Pre-Registration

 
We are now scheduling COVID-19 vaccination appointments.  
 
Please complete the form below and we will be in touch to schedule your COVID-19 vaccine appointment. 
 
By completing this form, you are agreeing that NATIVE HEALTH may send you a registration request at the email address you provide on this form, that you understand that NATIVE HEALTH cannot guarantee the security of the messages it sends and that there is a risk the message may be intercepted and read by a third party.
  • *Please note: this is a Pre-Registration Form. You will need to complete a COVID Vaccination Consent Form and Packet upon arrival.


  • NATIVE HEALTH often find it convenient to communicate by text messaging. Such communications may include, but are not limited to, appointment reminders, providing test results, information about available services and other notices related to NATIVE EALTH and the Vaccine Administration Management Systems (VAMS) as well as COVID vaccine reminders. Because text messaging is not secure methods of communication, there is some level of risk that text message could be read by a third party and NATIVE HEALTH cannot assure the confidentiality of information that it sends to you, or that you send to NATIVE HEALTH through text messaging. By signing this form, you are acknowledging these risks. You are not required to agree to accept such calls or messages from NATIVE AELTH as a condition of receiving services. I understand that NATIVE HEALTH's Notice of Privacy Practices is available to me online and I can access it at any time at this link.