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Welcome, we are a group of volunteer highschool students. As you may have already experienced with COVID-19 vaccine appointment booking online, it is a daunting process with low success rate. We are here to help you. Providing insurance information is optional. If you are not comfortable in giving out your information, please feel free to use our online resource (Fill in) to register on your own.

First Name*

Middle Name (Optional)

Last Name*

Gender*

Age*

Phone Number*

E-mail*

Street Address*

State*

City/Town*

ZIP Code*

What is the farthest town/city you are willing to travel to? (Optional)

What is the maximum amount of MILES you are willing to travel from your home? (Optional)

Please select the days where you would like to schedule your vaccine appointment.*
Every DayMondayTuesdayWednesdayThursdayFridaySaturdaySunday
Please select the time of day where you would like to schedule your vaccine appointment.*
Morning Hours
All Times Before Noon8am-9am9am-10am10am-11am11am-2pm
Afternoon Hours
All Times After Noon12pm-1pm1pm-2pm2pm-3pm3pm-4pm4pm-5pm5pm-6pm6pm-7pm7pm-8pm
If you have any of these underlying medical conditions, please select them below.*
I do not have any underlying medical conditionsCancerChronic kidney diseaseCOPD (chronic obstructive pulmonary disease)Down SyndromeHeart conditions, such as heart failure, coronary artery disease, or cardiomyopathiesImmunocompromised state (weakened immune system) from solid organ transplantObesity and severe obesity (body mass index (BMI) of 30 kg/m2 or higher)PregnancySickle cell diseaseSmokingType 2 diabetes mellitusAsthma (moderate-to-severe)
Vaccine Choices*

If you are unsure of what each vaccine is, click here to find their descriptions:
No PreferenceModerna/NIAID VaccineJohnson & Johnson VaccineBioNTech/Fosun Pharma/Pfizer vaccine
Notes for Scheduling (Optional) (500 Characters Allowed)

Number of Characters Left: 500
Liability Agreement
This agreement releases VPal from all liability. VPal does not take any responsibility for any accidents that may occur.
VPal is not responsible for information on any third-party web site that is referred in, or accessible or connected by hyperlink to, the Site. Further, VPal is not responsible for any technological problems or any impact that they may have.
This disclaimer of liability applies to any and all damages or injury, including those caused by any failure of performance, error, omission, interruption, deletion, defect, delay in operation or transmission, computer virus, communication line failure, theft, destruction or unauthorized access to, alteration of or use of any asset, whether for breach of contract, tortious behavior, negligence or under any other cause of action.
By signing below, I forfeit all right to bring a suit against VPal for any reason; I agree to hold VPal entirely free from any liability. By signing this agreement, I will be responsible for any liability to VPal that arises out of my use of this site. I hereby agree to indemnify, defend and hold VPal and its affiliates harmless from and against any and all suits, liability, losses, damages, costs, and expenses (including reasonable attorneys' fees) that arise from or relate to my use of the site or violation of any applicable law, statute, ordinance, regulation or of any third-party's rights.

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