This is an appointment request form for the Colquitt Regional COVID-19 vaccine clinic. Effective Thursday, March 25th, anyone over the age of 16 is eligible to receive a vaccine.

An appointment is required to receive the vaccine, we do not accept walk-ins.
*Please note: Your second vaccine will be scheduled at the same time your first vaccine is scheduled so you will receive two separate vaccine dates and times.*

To help expedite the registration process, please print and fill out this Consent Form. Bring this form with you to your appointment.