COVID-19 Vaccination Appointment Booking

Select Date and Time:
Appointment Date and Time*
* Please note: If the current time listed next to the time zone (America/Chicago) does not match your current time, please select a new time zone that does match.
Appointment Date and Time 2

MonthDayYear
Date
Hour MinutesAM/PM Option
Adjusted Time

Patient Information
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
** Please remember to bring your vaccine card with you to your appointment. **
Are you a Springfield Clinic employee?*

NoYes
Current

MonthDayYear
Date
Age
Should be Empty: