Covid-19 Vaccine - AHS Patient Waitlist

Please answer all questions. This waitlist is only for patients of Asian Health Services. Your Asian Health Medical Record Number is required and will be verified before you are added to our COVID Vaccine Waitlist.

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* 1. Please enter your Asian Health Medical Record Number (MRN or ID#).

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* 2. Please enter your name.

Last Name

First Name

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* 3. Please enter your date of birth.

Date of Birth Format: MM/DD/YYYY

Date

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* 4. Please select your occupation.

Healthcare

Education or Childcare

Emergency Services

Food Services or Agriculture

Other

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* 5. In case there is a last minute opening for an appointment, are you able to travel to our Chinatown clinic, at Webster and 8th St. Oakland, within 1 hour of getting a call from us?

Yes

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* 6. Please enter your mobile number and we will notify you via phone or text when a COVID vaccine appointment becomes available.

Phone Number