Memorial Hermann's COVID-19 Vaccination Request Form


By completing Memorial Hermann's COVID-19 Vaccination Request Form, you will be registering for the opportunity to receive the COVID-19 vaccine at a Memorial Hermann vaccination clinic. Registered individuals who meet eligibility for vaccination will be selected at random and notified when appointments are available. Memorial Hermann will make appointments available based on vaccine supply and will prioritize vaccine distribution in accordance with guidance from the Texas Department of State Health Services. Due to the limited supply of vaccine, it may be an extended period of time before you have the opportunity to get vaccinated. If you have the opportunity to receive vaccination elsewhere in the meantime, we encourage you to do so. To learn more, click here.

After submitting your form, please look out for a text message from Memorial Hermann or email from MHVaccination@memorialhermann.org to complete your request to receive the COVID-19 vaccine.