Memorial Hermann Announces its Online COVID-19 Vaccination Request Form

HOUSTON (March 09, 2021)

As part of its role as a state-designated COVID-19 vaccination distribution hub, Memorial Hermann Health System is proud to announce the launch of a digital COVID-19 Vaccination Request Form. Eligible members of the community can now use this online tool to register for the opportunity to receive a COVID-19 vaccine from Memorial Hermann.

In Texas, vaccination is currently available to the state’s Phase 1A and 1B priority groups, as well as to those who work in school and/or childcare operations as defined by the U.S. Department of Health and Human Services (DHHS). Once the online request form has been completed, individuals will be placed on a waitlist for future appointments at Memorial Hermann’s vaccination clinics. Registered individuals who meet eligibility for vaccination will be selected at random and notified when appointments are available. A link to schedule the vaccination will be sent via text message and/or email based on the communication preferences entered when completing the request form.

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. Please see below for descriptions with more detail on current qualifications.

Those who qualify and are interested in completing Memorial Hermann’s COVID-19 Vaccination Request Form are invited to sign up here.

Phase 1A:

  • Frontline healthcare workers
  • Long-term care facilities
  • EMS 9-1-1
  • Home Health
  • Outpatient
  • Medical Clinics
  • ER/Urgent Care
  • Pharmacies
  • Last Responders
  • School Nurses

Phase 1B:

  • Individuals 65 years of age and older
  • Individuals 18* and older who have at least one chronic medical condition that puts them at increased risk for severe illness from the virus that causes COVID-19 as defined by the state’s Phase 1B criteria

DHHS defines those who work in school and/or childcare operations as:

  • Teachers for pre-primary, primary or secondary schools (including Head Start and Early Head Start programs);
  • Staff at pre-primary, primary or secondary schools (including Head Start and Early Head Start programs);
  • Bus drivers for a pre-primary, primary or secondary schools (including Head Start and Early Head Start programs); and
  • Staff at licensed childcare providers.

*Memorial Hermann will soon offer vaccination for minors (age 16-17) who meet the state’s Phase 1B criteria. Additional information will be coming soon.