COVID-19 Phase 4 Vaccination Registration Form
The following people are considered eligible for vaccination in Phase
Name
First Name
Last Name
Email
example@example.com
Phone Number
County
City/Town
Phase 4 Group
Everyone residing in Georgia for whom the vaccine is recommended, who was not included in any of the previous phases.
Children, once the vaccine is approved for pediatric use.
Other
Other
Only certain health departments currently have vaccine. Please select which health department you prefer to be contacted by for your vaccine appointment:
Columbus
Dooly
Crisp
Talbot
Chattahoochee
Marion
Taylor
Stewart
Clay
Quitman
Randolph
Schley
Macon
Harris
Webster
Sumter
Submit
Should be Empty: