2. REGISTRATION GROUP
   Registration is currently open for ALL GROUPS (Moderna-18 years and older; Pfizer-16 years and older).
4. First Name*
5. Last Name*
7. Have you already received the first COVID-19 Vaccine dose?*

   1. No
   2. Yes
9. Have you tested positive for COVID within the last 90 days AND treated symptoms with monoclonal antibodies or convalescent plasma?*

   If unsure, please contact your Primary Care Provider

   1. No
   2. Yes
11. Are you currently in quarantine or awaiting COVID test results?*

    1. No
    2. Yes
12. Have you received an immunization within the last 14 days?*

    1. No
    2. Yes

    Based on CDC guidelines, vaccines cannot be given within 14 days of each other.
14. Please choose your age range.*

    1. 0 - 15 years old
    2. 16 - 17 years old
    3. 18 years and older
16. Congratulations! You qualify to receive the COVID Vaccine.*

    YOU'RE NOT DONE YET! Click SUBMIT at the bottom to proceed to SignUpGenius and book your appointment. You will need your basic demographic information such as name, date of birth, contact number and email address. If you do not have an email address or are unable to complete the appointment process, please contact us at (252) 636-6693.

    1. By checking this box, I certify that I have provided complete and accurate information to the best of my knowledge.
18. Congratulations! You qualify to receive the COVID Vaccine.

    1. By checking this box, I certify that I have provided complete and accurate information to the best of my knowledge.

    YOU'RE NOT DONE YET! Click SUBMIT at the bottom to proceed to SignUpGenius and book your appointment. You will need your basic demographic information such as name, date of birth, contact number and email address. If you do not have an email address or are unable to complete the appointment process, please contact us at (252) 636-6693.
20. PLEASE CONTACT US TO SCHEDULE YOUR SECOND DOSE

    1. Please contact our office at (252) 636-6693.
22. PLEASE TRY AGAIN LATER

    Unfortunately we cannot register you at this time due to requirements or appointment type availability.

    1. For the latest COVID-19 vaccine information, please visit our website or follow us on Facebook. You may also call us at 252-636-6693.
24. COVID-19 Vaccine Group Chart
    https://files.nc.gov/covid/documents/vaccines/NCDHHS-Vaccine-Infographic.pdf
26. Craven County Website
    https://www.cravencountync.gov/2160/Vaccine-Information
27. Craven County Facebook
    https://www.facebook.com/cravencountyhealth
Leave This Blank:


28. Submit

* indicates a required field