COVID-19 Vaccine PHASE 1A Registration Form
This registration is for PHASE 1A Healthcare Personnel only.
You will be automatically booked for your second dose 3 weeks from your appointment on the same day and time. Please choose a day and time that will work for your 1st and 2nd dose appointments
Name*
First Name Last Name
Birth Date*
Month Day Year
Date
Phone Number*
Please enter a valid phone number.
Name of Healthcare Organization you work for?*
Email
example@example.com
Available Appointments*
If you have questions please call the West Allis Health Department at 414-302-8600.
Should be Empty:

COVID-19 Vaccine PHASE 1A Registration Form