Cullman Regional has received the COVID-19 Vaccine and is following the distribution plans outlined by the Alabama Department of Public Health. We will provide more information as we receive it. If you would like to join the waiting list for our Community COVID-19 Vaccination Clinics, please complete the form below.

1-8-2021 UPDATE: The Alabama Department of Public Health announced that the COVID-19 vaccination program will be expanded to include people 75 years and older effective January 18, 2021. If you have signed up on our waiting list, we will contact you directly if we have an appointment available.

Completing this form is not a guarantee of an appointment as we have a limited supply of the vaccine. Information about additional vaccination locations is available on the ADPH website.


Request form to be put on waiting list

We will contact you by phone when we have an appointment available. Completing this form is NOT a guarantee that you will receive an appointment as we have a limited supply of vaccine. If you are available on short notice to fill in gaps in our schedule, please indicate that below.

For anyone who does not have internet access, you can access the printable form here and have them send back to us: Printable Form Link

  • Date Format: MM slash DD slash YYYY
  • (Ex. Blue Cross Blue Shield, Medicare, Medicaid, United Healthcare, etc.)
  • Please select any of the following that apply to you: