If you are interested in getting a COVID-19 Vaccine from the ONHS WahZhaZhe Health Center please complete this form to be placed in a queue to receive your COVID-19 Vaccination.  

Also please note:  Our COVID19 Vaccine Scheduling team is developing a list of names from the people completing this survey – this is one of several different methods we are using in an attempt to collect the names and contact information of people interested in getting the COVID-19 Vaccine.

Once you have submitted your name and contact information one of our COVID-19 Vaccine Scheduling team members will begin calling patients* on their list according to priority guidelines from CDC and APIC. We want to remind everyone that we are limited by the number of vaccines allocated to us by IHS/HHS. So we kindly ask everyone to please be patient as it is our utmost priority to reach out to everyone on our list to schedule vaccine appointments as quickly as we can. Please watch our Facebook page for continued updates/news on our COVID19 Vaccine efforts. ThaDli!

*You must have an active health chart established at our clinic in order to receive a COVID19 vaccine from WZZHC. Below is the link to the WZZHC "New Patient Application"


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* 1. I confirm that I want to receive the COVID-19 Vaccination from the WahZhaZhe Health Center

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* 2. If you have any health/social/environmental issue(s) that you believe should be considered when placing your name on our COVID19 Vaccine wait-list please inform us below:

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* 3. Your contact info:

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* 4. How would you like to receive additional information about getting your COVID-19 Vaccine from ONHS WahZhaZhe Health Center?