Make COVID Vaccine Appointment

Make COVID-19 vaccine Appointment – EMPLOYEES ONLY

In the event of a medical emergency, call 911 immediately.

We’d like to make it easier for you to make a COVID appointment. Fill in the Patient Information below and the referral center will contact you to confirm your request. Be sure to fill in the Best Time To Call and Appointment Reason sections so that we can assist you more efficiently. You can expect a response within two business days. Currently this option is available for “EMPLOYEES ONLY”

At NuHealth we respect your privacy and want to ensure your peace of mind. We will not share or sell your contact information under any circumstances to a third party.

Patient Information

Employee*

YesNo

Employee Number*

First Name*

Middle Initial

Last Name*

Address

City

State

Zip

Date of Birth*

Health Insurance

Primary Care Physician

Contact Information

Phone

Department Information

Supervisor First Name*

Supervisor Last Name*

Department*

Appointment Information

Specialty*

Preferred Date/Time *

Additional Information

Best Time to Call

A.M.P.M.

Our referral center will attempt to contact you within 2 business days.