Vaccine Waiting List - Johnson Memorial Health Services

If you are a current JMHS patient and/or a resident of Minnesota, please fill out the form below to be added to our waiting list. Please note at this time we are only allowed to give COVID-19 Vaccines to State residents.

Waiting List

Name*
First Last
Date of Birth*

Please use this format: mm/dd/yyyy
Age*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email
Booster Shots
The CDC is recommending an additional dose of mRNA COVID-19 vaccine when the immune response following the two-dose primary series is likely to be insufficient. This is recommended for moderately to severely immunocompromised people or adults over 65 years old. If you are wanting a Booster shot, please list what COVID-19 Vaccine you were previously given.
Booster
- Pfizer
- Moderna*
- Johnson & Johnson*
*Waiting for approval
Phone
This field is for validation purposes and should be left unchanged.

Waiting List

Booster Shots