St. Mary's Athens Community Covid Vaccine

Thank you for your interest in receiving the CoVid-19 vaccine through

St. Mary's Hospital in Athens, GA.

We are happy to extend our availability of the vaccine to our community. Please complete this form if you are interested in receiving a call to be scheduled for the vaccine. The following tips will help us help you efficiently schedule your vaccine.

1) List your best phone number.

2) Calls from St. Mary's may display as "unknown caller", please answer unknown calls.

For detailed information on Georgia's Vaccine Distribution click here.

Are you interested in setting up your 1st dose of the vaccine?

Yes No

We will only be offering the Moderna vaccine for those starting the series.

Are you inquiring about receiving the 3rd dose of the COVID-19 vaccine?

Yes No

Which COVID-19 vaccine series did you receive for doses 1 and 2?

Pfizer Moderna

I acknowledge I will receive the same brand of vaccine that I received for doses 1 and 2, as recommended by the CDC.

Name*

First Name

Last Name

Date of Birth*

Phone*

Email

I understand this vaccine request is for St. Mary's Hospital in Athens, GA.*

*If you would like to request an appointment at one of our other two hospital locations. Please visit their websites using the corresponding links below.

St. Mary's Sacred Heart Hospital - Lavonia, GA

St. Mary's Good Samaritan Hospital - Greensboro, GA

Please DO NOT call the hospital or complete more than one form.

If you entered your email above you will be sent a confirmation of your submission of interest to receive the vaccine. We will call and schedule your appointment as soon as possible. We appreciate your continued patience throughout this process.

I agree and acknowledge the above statements.

CoVid-19 Vaccination Registration