COVID-19 Vaccine Interest Form - St. James Episcopal Church |
Houston Methodist is proud to partner with St. James Episcopal Church to help its members, aged 50 or older, schedule a COVID-19 vaccine.
If you are under the age of 50, you must meet the criteria of pre-existing conditions per Phase 1B description and be no younger than age 40. If you fill out this form, we will contact you via text message to help schedule a vaccination appointment. In the text, there is a contact number if you need assistance with scheduling. If you do not have a mobile number, you will be contacted at your home number to schedule. You may also be contacted via your email address, so we encourage you to fill out as many fields as possible. If needed, Houston Methodist can also assist with transportation. From the date of sign up, it may take Houston Methodist up to 3 weeks before making contact so we ask for your patience. Thank you for joining our fight to stop the spread of this virus.
You must be 40 - 49 years of age, meeting the Phase 1B criteria OR 50+ regardless of health status to be eligible for scheduling.
Phase 1B Criteria
Those aged 40-49 must have one or more of the following conditions to be eligible for scheduling a vaccine appointment:
You must be 40 - 49 years of age, meeting the Phase 1B criteria OR 50+ regardless of health status to be eligible for scheduling.
Phase 1B Criteria
Those aged 40-49 must have one or more of the following conditions to be eligible for scheduling a vaccine appointment:
- Cancer
- Chronic Kidney Disease
- COPD (Chronic Obstructive Pulmonary Disease)
- Down Syndrome
- Heart Conditions, such as Heart Failure, Coronary Artery Disease or Cardiomyopathies
- Solid Organ Transplantation
- Obesity and Severe Obesity (Body Mass Index of 30 kg/m2 or higher)
- Pregnancy
- Sickle Cell Disease
- Type 2 Diabetes Mellitus
Please complete the COVID-19 Vaccine Interest Form by Noon on Friday, March 19.