Please complete the form below. After the form is completed, a Mercer Health staff member will call you to schedule an appointment to receive the vaccine. Vaccine supply is very limited. Please do not call to inquire about vaccine appointment availability. If you have completed this form we will call you when it is your turn to be scheduled. Age eligibility requirements must be met and priority will be given to age. By completing this form you are consenting to receive emails and/or phone calls from Mercer Health.