COVID-19 Vaccine

Vaccine Registration and Scheduling

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Vaccine Registration and Scheduling
Now scheduling COVID-19 vaccination for the general public.

Notification List Signup

A safe and effective COVID-19 vaccine plays a critical role in providing protection against the virus, preventing illness and saving lives. Vaccine is currently in limited supply and health officials are using a phased approach.

This simple form allows you to register to receive vaccine. Please add your name and contact information below and the Lincoln-Lancaster County Health Department will notify you when vaccine is available.

Group: *

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

Health Information

Are you restricted or confined to your home? Yes

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

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

Vaccine Registration and Scheduling

Notification List Signup

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