COVID 19 Vaccine Appointment Request

Thank you for choosing Infirmary Health! To schedule your vaccine appointment, a MyIHChart account is REQUIRED. If you do not already have a MyIHChart account, please visit the account signup page, https://www.myihchart.org/MyChart/signup.

If you have an existing account, please login at https://www.MyIHchart.org, where you can review past and future appointment and notifications and lab/diagnostic results at Infirmary Health. You will schedule your COVID-19 vaccine appointment from within your MyIHChart account.


Demographic Information:

Please select which best describes you:




Critical Workers:




















Full Legal Name:
Date Of Birth: e.g. 05/15/1965
Address:

 (No PO Box)

City/ST/Zip:

   
   
Home Phone: e.g. (251) 555-1234
Cell Phone: e.g. (251) 555-1234
Social Security Number: e.g. 555-55-5555
Email Address:
Preferred Location: