ENROLLMENT: COVID-19 Vaccine for YOU

Thank you for your interested in receiving the COVID-19 vaccine through the ministry of caring at St. Joseph Primary Care.    

Once you registered, and it’s your turn, we will notify you via text or email for you to confirm your appointment, date and time, and location for you to receive your vaccine.  YOU MUST CONFIRM your appointment.  If you do not confirm, you do not get a shot.  In order to make the vaccine accessible to everyone, we are working with our community partners.  These are the four locations that you may come to receive the vaccine.  We’ll add more locations in the future.

St. Joseph Primary Care – St. Ann Catholic Church – Our Lady of Lavang Catholic Church, and Cardinal Gibbons High School.

DONATE – $1 DOLLAR TO HELP OUR NEIGHBORS

Currently, we are running a campaign – VACCINE FOR OUR NEIGHBORS, bringing the COVID vaccine to the historically marginalized populations and providing them with care and love.  St. Joseph Primary Care is the only provider in Wake County to obtain the highest mark in vaccination percentage for the Hispanic community and number two in NC to vaccinate the Asian population. There is NO cost to receive the vaccine.  We don’t ask for your insurance.  Our goal is to save many lives as possible.  Thus, we work around the clock to bring the vaccine to you.  If you can, please consider making a $1 donation to the campaign – Vaccine for our Neighbors, doing little things with love so that we can end this pandemic soon.  Your gifts help us to continue to MAKE A BIG DIFFERENCE. Please join us “It’s in giving that we receive” St. Francis.

DOWNLOAD GENERAL – REGISTRATION FORM IN SPANISH —- DOWNLOAD GENERAL – REGISTRATION FORM IN ENGLISH

First name: ^*

Last name: ^*

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Home 123456789: ^*

Cell phone 123456789: ^*

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REQUIRED: Date of Birth (mm/dd/yyyy): ^*

Race: ^* -Select One-AsianBlack/African AmericanNativeHawaiian or Pacific IslanderWhiteOther RaceDeclined to answer

Ethnicity: Hispanic or LatinoNot Hispanic or Latino

Sex: -Select One-MaleFemaleDeclined to Answer

How did you know about us?: ^* -Select One-Declined to answerGroup 4ClergyEssential WorkersFirst RespondersI do not go to churchChristian ChurchCatholic ChurchCardinal Gibbons High SchoolSt. Ann Catholic ChurchSt. Joseph Primary CARESt. Joseph Catholic ChurchSt. Francis of Assis Catholic ChurchSt. Eugene Catholic ChurchSt. Michael the Archangel Roman Catholic ChurchSt. Catherine of Sienna Catholic Church, Wake ForestImmaculate Conception Catholic ChurchHoly Name Of Jesus CathedralOur Lady of Lourdes Catholic ChurchOur Lady of Lavang Catholic ChurchOur Lady of Rosary Catholic Church, LouisburgFrom a friendSocial Media

Is this your 1st dose of COVID19 vaccine?: YesNot sure

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