Community COVID-19 Pfizer BOOSTER Appointment Form

Community COVID-19 Booster Appointment Form

NORTHERN LOUISIANA MEDICAL CENTER
Appointment *
Name *

First Name Last Name
Email

Confirmation Email example@example.com
Phone Number *
Please enter a valid phone number.
Date of Birth *

Month Day Year
Date
After scheduling your appointment, if you entered an email address, you will receive an email verification with an attachment containing vital information about your appointment: a consent form to print and complete in advance if you wish, documents to bring including your vaccination card, as well as the physical address and location of the vaccination site at NLMC.

Again, if you entered an email address, please take time to open the email attachment you will receive once your appointment is submitted and scheduled.

Thank you!

NLMC COVID-19 Vaccination Committee

Northern Louisiana Medical Center, Medical Office Building room 100

401 East Vaughn Ave.

Ruston, LA 71270
Should be Empty:

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