COVID-19 Vaccine

Vaccine Registration and Scheduling

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Now scheduling COVID-19 vaccination for the general public.

A safe and effective COVID-19 vaccine plays a critical role in providing protection against the virus, preventing illness and saving lives.

Print and fill out this document to bring with you to the scheduled appointment.

COVID-19 Vaccine Information
Get Vaccine Fact Sheets and Frequently Asked Questions. Learn about the COVID-19 Variants plus other resources for you and your family.

Homebound Residents or Children under 12
If you are homebound and need accommodations, click here to register or call 402-441-4200 for assistance.
If you are under twelve years of age, click here to register or call 402-441-4200 for assistance.

Please schedule your vaccination by filling out the form below.

Group:

Company/School: Public

Please Enter Your Information
First Name: *
Last Name: *
Date of Birth: * m/d/yyyy
All minor children 18 years of age and younger must be accompanied by a parent, court-appointed guardian or an authorized agent.

Gender: *
Race: *
Ethnicity: *

Please check if you are experiencing homelessness or have an unknown address:

Address:

City: *
State:
Zip: *

Do you have a mobile phone? Yes
Home Phone: (000) 000-000
Work Phone: (000) 000-000
Preferred Phone: *
Email:
Do you need an interpreter? Yes including Sign Language

Do you think you have a weakened immune system? Yes

Do you have any comments, concerns or if you need any accomodations:

View upcoming clinics by picking your preferred vaccine
Preferred Vaccine: Pfizer
Moderna *

First Name Required
Last Name Required
Date of Birth Required
Gender Required
Race Required
Ethnicity Required
Address Required
City Required
Zip code Required
Preferred Phone Required
Preferred Vaccine Required

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Vaccine Registration and Scheduling

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