Vaccine Appointment Finder Sign Up
Welcome. We're glad you're here!
The Village Presbyterian Church CARES about you, and we believe God has called us to HELP you.

If you need help with this registration process please feel free to call the church office at 847-272-0900.

IF YOU ARE UNDER 65 YEARS OLD: please confirm you are eligible for a vaccine by going through the questionnaire at: https://covidvaccination.dph.illinois.gov/questionnaire. The Illinois Department of Public Health states that those under 65 with a vaccine appointment need to "bring documentation to show you're currently eligible" and "If you are not eligible in this phase, your vaccination appointment will be rejected."

          (Confirming this will prevent
           OUR spending time to find an appointment
           YOU can't use. Thanks!)

Vaccine Appointment Finder Team
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Name (first and last; we suggest as it appears on your drivers license) *
Street Address *
City, State, Zip *
Birth date (month / day / year) *
MM
/
DD
/
YYYY
Primary Phone (the one you would be most likely to answer immediately) *
Cell phone (if not your primary phone)
Email address *
Do you have a history of severe reaction/anaphylaxis to vaccines? *
Have you had a vaccine (including flu shot) in the last 14 days? *
Have you been diagnosed with COVID-19 in the last 14 days? *
Are there any times/dates when you are unavailable? (PLEASE NOTE: the more limitations the less likely we'll be able to find an appointment)
Do you have any limitation on how far away an appointment can be? (We try to get as close as possible, but the more flexible you can be the better!) *
If we find an appointment for you, will you be able to get there on your own, or will you need help with transportation? *
Are you a US military veteran? *
Have you registered with Cook County? *
Do you have a Walgreen's account? (We're currently having our best success with Walgreen's so it can speed things up for us if you have an account linked to your email/phone number.) *
Is your medical care with NorthShore HealthSytem, Northwestern Medicine, or Loyola Medicine? *
IF YOU ARE UNDER 65: please confirm you are eligible for a vaccine by going through the questionnaire at: https://covidvaccination.dph.illinois.gov/questionnaire. The Illinois Department of Public Health states that those under 65 with a vaccine appointment need to "bring documentation to show you're currently eligible" and "If you are not eligible in this phase, your vaccination appointment will be rejected." (Confirming this will prevent our spending time to find an appointment you can't use. Thanks!) *
Final Comments: Are there any further things you think we should know before beginning the search for your appointments?
How did you hear about our team? *
BEFORE YOU CLICK "SUBMIT" (Here's what will happen next)
A member of the Vaccine Appointment Finder Team will be contacting you by phone before beginning your search. When they call they may ask for some additional information to help them find your appointment. Information they might ask for may include your Cook County registration code (if you've registered), and information about your Walgreen's account (if you have a Walgreen's account). Please answer your phone over the next few days so we can talk to you!

If you have any questions about this process please feel free to contact me at 847-800-7119.

The team is looking forward to finding you your vaccination.

Chuck Guth (Minister of Discipleship and Congregational Care)
The Village Presbyterian Church, Northbrook, IL
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