COVID-19 Vaccine Pre-Registration

People in Phase 1B, as determined by the Ohio Department of Health (ODH), can now pre-register to schedule a COVID-19 vaccine appointment with University Hospitals.

Phase 1B are people who either:

Are age 65 and older
Are an employee of a K-12 school
**Have severe congenital, developmental or early-onset medical disorders such as: cerebral palsy; spinal bifida; congenital heart disease; type 1 diabetes; inherited metabolic disorders; severe neurologic disorders, including epilepsy; severe genetic disorders including Down syndrome, Fragile X, Prader-Willi Syndrome and Turner Syndrome; severe lung disease, including cystic fibrosis and severe asthma; sickle cell anemia and alpha- and beta-thalassemia; and solid organ transplant patients.

If you are eligible, University Hospitals invites you to pre-register to receive a COVID-19 vaccine by completing the form below.

Enter your contact information, choose how you would like to be contacted and submit the form.
When it is your time to schedule your vaccine appointment, based on ODH guidelines and vaccine availability, you will be contacted via the method you chose on the pre-registration form and be provided a special phone number to call to schedule your vaccine.
At this time, vaccinations will be administered at the UH Management Services Center, 3605 Warrensville Center Rd. in Shaker Heights.

If you do not have an email, you can easily create one with Microsoft or Google.

Please know you must be in one of the above groups and have a scheduled appointment with us to receive the COVID-19 vaccine.

* = required

Have you already received a COVID-19 vaccine?

Yes No

Legal First Name

Legal Middle Initial

Legal Last Name

Date of Birth (MM/DD/YYYY)

Gender

Male Female

Address

Address 2

City

State

Zip Code

Home Phone Number (000-000-0000)

I prefer to be contacted via:

Email Text

Cell Phone Number (000-000-0000)

By providing your Cell Number you agree to opt-in to receive text messages from 84669(UHNOW) "UH Info" related to scheduling, referral order reminders, health care reminders (e.g., annual wellness exams, eye exams, etc.), health care recommendations, UH policy changes that may impact you, and/or UH announcements related to accessing care (e.g., construction-related detours or delays) and more. By selecting to opt-in, you agree to our SMS terms & conditions and to receive notifications from 84669(UHNOW) "UH Info" at the cell number provided. Consent is not required to obtain services or transact with University Hospitals. Message and rates may apply. Frequency may vary.

Text STOP to 84669(UHNOW) to opt-out or HELP for help.

Email Address

Do you provide hands on health or medical care to clients/patients?

Yes No

I am part of the following category (choose the first category you fall into):

I certify that to the best of my knowledge and belief the information provided, including for scheduling prioritization, is complete and correct.