COVID-19 Vaccine Form

  • If you are a 1A.3 health worker (see list below) who has not already been contacted by us please call today to schedule a Covid vaccine appointment.
  • - primary care
  • - occupational health
  • - urgent care
  • - University health center
  • - school nurses
  • - dental
  • - pharmacy
  • - home health
  • - private/personal care
  • - hospice
  • - dialysis
  • - blood donation center workers
  • - EMS patient transport
  • - first responders
  • - fire
  • - police

If you are not in this group, PLEASE do not call or message us. We appreciate your patience as we work through this difficult process. Your health-care is our top priority. At this point our primary responsibility is to follow the guidelines provided by the Arkansas Dept. Of Health. Our goal is to make sure everyone that wants to receive the vaccine will receive it as quickly, efficiently, and safely as possible.

    The link below is for the emergency use authorization form for the COVID-19 vaccine. You must read and acknowledge this form before you can print the vaccine form and receive the vaccine.

    COVID-19 Vaccine Emergency Use Authorization (EAU) Form