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請回答所有問題。 該等候名單僅適用於亞健社會員。請務必填寫您的亞健社會員號碼。我們將核實會員號碼后再將您的資料添加至我們的新冠病毒疫苗等候名單。

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. 請輸入您的亞健社會員號碼(MRN)。
Please enter your Asian Health Medical Record Number (MRN or ID#).

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影像

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影像

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* 2. 請輸入您的名字。
Please enter your name.

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* 3. 請輸入您的出生日期。
Please enter your date of birth.

日期

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* 4. 請選擇您的職業。
Please select your occupation.

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* 5. 如果有臨時候補預約開放,您是否可在收到我們通知后1小時内到達診所? (Webster 和 8街, 屋崙)
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?

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* 6. 請輸入您的手機號碼,當接種新冠病毒疫苗預約開放時,我們將通過電話或手機短信通知您。
Please enter your mobile number and we will notify you via phone or text when a COVID vaccine appointment becomes available.

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