JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Booster Clinic
This form is for the on-site booster vaccination clinic next Wednesday (11/17). The time is from 4pm to 7 pm If you are interested, select which booster you need. This booster is for ages 12 and up only.
https://idph-mychart.pchosted.com/IDPH/signupandschedule/embeddedschedule?vt=24629&dept=9001410010998
Here is a link to get a time although there could still be a wait.
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Phone Number*
*
Your answer
Which Booster shot would you be needing?
*
Moderna
Pfizer
J&J
Unknown
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Unity Point CCSD140.
Report Abuse
Forms