Alachua County COVID-19 Vaccine Waitlist

To be added to the waitlist or update your your information on the waitlist, fill out the form below. If you sign up for our waitlist, we will reach out to you via text message and/or email when new appointments are available.

For more information, visit the COVID-19 Information page on the DOH Alachua website. For persons with hearing or speech related disabilities TDD/TTY is available, please contact the Florida Relay Service at (800) 955-8771(TDD) or 711 (V/TDD).

Note: * Indicates a required field.

Personal Information

First Name

Last Name

Date of Birth

Month of birth

Day

Year

Year of birth

Mobile Phone Number

Landline Phone Number

Your email address and phone number(s) will only be used for communications related to these vaccination efforts.

Sex

Ethnicity

Race

Vaccine Prioritization Group

Please indicate below if you are a member of one the prioritization groups. More information about the these groups can be found on the DOH Alachua COVID-19 web page.

Required documentation for those deemed extremely vulnerable to COVID-19 by their medical provider

Required Form: COVID-19 Determination of Extreme Vulnerability

You are REQUIRED to provide this form at check-in on the day of your appointment. We will accept only this form; a doctor's note will not be sufficient. To avoid delays or cancellation do NOT schedule an appointment until you have the completed form in your hands.

Home Address

Street

City

State

ZIP Code

No longer interested?

If you have already been vaccinated or would like to be taken off the waitlist, submit the opt out form to be removed.

The Florida Department of Health in Alachua County manages this COVID-19 vaccination program. Support is provided by UF Health, the University of Florida's academic health center. This website is maintained by the University of Florida. The data contained herein is used for scheduling purposes only and does not constitute a medical record.

Contact Information