COVID- 19 Vaccine Appointment Request

If you are part of the phase 1A, 1B or 1C priority groups for vaccinations as directed by the state of Maryland, you are eligible for a vaccine. With the exception of seniors and employees of the Washington County Public Schools, those in the priority groups should fill out this form for the local health department to be added to its list to receive a call about an appointment.

Washington County Public Schools employees - WCPS is making arrangements for its staff to receive vaccines in partnership with area health care providers. This information will be shared with all WCPS employees as details are finalized.


Please complete the form below to be contacted for a COVID- 19 vaccine appointment.

You will be contacted to schedule your vaccine appointment in the order in which your request has been received.

Please note that appointment scheduling of the COVID-19 vaccine is based on the availability of the vaccine being received. This process may take weeks based on availability of vaccines.

* Required
  • Please enter your first name.
  • Please enter your name.
  • This isn't a valid phone number.
    Please enter your phone number.
    You entered an invalid number.
  • Please enter your Date of Birth.
    Please use this format (MM/DD/YYYY)
  • Please select a preferred language.
  • Please select a communication preference.