Banner Employer Solutions
Chase Field
., . .
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There are no visit times available for online scheduling right now.
Please enter information below to register for your COVID Vaccine. If you believe you are having a medical emergency you should
call 911
or go to the nearest emergency room immediately.
Please fill in additional patients.
COVID Vaccination
The clinic has reached its limit for this visit reason today.
Patient First Name
Patient Last Name
Visit Day
Today - 11/14/2024
Visit Time
Cell Phone Number
Date of Birth
Address
City
State
Zip Code
Gender
---
Female
Male
Unspecified
We'll send you a text message reminder one hour prior to your scheduled arrival time.
minutes before my visit
I have reviewed the information
on when to call 911
.
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