Close

COVID-19 Request Vaccine

Request COVID-19 Vaccine

If you are low-income or uninsured, you may register for your COVID-19 vaccine by completing the form below or by calling 770-503-1369 x301 to leave a message request. After submitting your request either via the form or by phone, we will contact you to schedule your vaccine appointment.

Vaccines will be administered by appointment only.

Request Form for COVID-19 Vaccine Appointment
  • Date Format: MM slash DD slash YYYY