Chapel Hill COVID-19 Vaccine Appointments

Which COVID-19 Vaccine Dose do you need? *

If you are needing the new Moderna Booster shot, please select booster dose.

Select Appointment Date/Time *

Calculation for Appointment Date for Form

Would you like to get your flu shot at the same time?

Name *

First Name Last Name

Date of Birth *

Phone Number *

Email for appointment confirmation

example@example.com

Street Address *

City *

State *

Zip Code *

Do you have insurance? *

If you do not have insurance, please bring a valid government ID with you to your appointment.

If you have private/commercial insurance please make sure your card has prescription coverage information on it (this will include numbers like Rx Bin)

If you are covered under Medicare please bring your red-white-and blue card that has your Medicare number on it.

If you are covered under Medicaid your card should have your DCN number on it.

The COVID-19 Vaccine is free regardless of insurance coverage, but providing your insurance if you have it or an ID makes the process easier for us. We appreciate your cooperation and understanding!

Date