COVID-19 Vaccination Pre-Registration - Village of Skokie - V2

The Skokie Health and Human Services Department is working to get the COVID-19 vaccine to all residents and healthcare workers within the Village of Skokie. The Village is following the guidelines of the Illinois Department of Public Health and will be providing vaccinations in a multi-phased approach where those most at-risk will be offered the vaccine first. For more information on these phases, click here.

Steps:

Complete this pre-registration. Only Skokie residents and/or workers that work at a Skokie located healthcare provider are eligible to register. Proof of Skokie residency and/or if applicable employment at a Skokie healthcare facility is a requirement to complete this pre-registration.
You will receive a notification from the Village of Skokie when you are eligible to make a vaccination appointment. The notification will include a link to register for the vaccine clinic. The Village will move to new phases as sufficient doses of the vaccine become available.

Each household member must pre-register separately. You must answer every question.

YOU WILL NOT RECEIVE A CONFIRMATION EMAIL

Phase Descriptions:

Phase 1A: A healthcare, long-term care facility or congregate facility (group home) worker.

Phase 1B: Persons 65 or older and front-line essential workers.

PHASE 1B+: Persons aged 16 to 64 years old with high-risk medical conditions including cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, heart conditions, immunocompromised states from a solid organ transplant, smoking, obesity, pregnancy, pulmonary disease and/or sickle cell disease.

FINAL PHASE: Skokie residents that do not qualify for phases 1A, 1B or 1B+.

Question Title

* 1. Which vaccination phase most accurately depicts you? Pick only one phase.

Question Title

* 2. CONTACT INFORMATION:

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Primary Phone Number:

Email address:

Birthdate (MM/DD/YYYY)

To stay up to date with the most current COVID-19 vaccine information, please click here to subscribe to the Village of Skokie electronic newsletter.