If you are attempting to secure the COVID-19 vaccine for yourself, a colleague, or a loved one, please complete the form below and, as possible, staff from IDHS will be in touch to support you.
You can call 1-833-621-1284 or visit CovidVaccination.DPH.Illinois.gov to register for the COVID-19 vaccination.
First Name:
Last Name:
Email:
Cell Phone:
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Residence County: Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland DeKalb DeWitt Douglas DuPage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox Lake LaSalle Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac McDonough McHenry McLean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saline Sangamon Schuyler Scott Shelby St. Clair Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford Other
Health Department: Adams County Bond County Boone County Brown County Bureau County Calhoun County Carroll County Cass County Champaign County Champaign-Urbana Chicago Christian County Clark County Clay County Clinton County Coles County Cook County Crawford County Cumberland County DeKalb County DeWitt-Piatt Douglas County DuPage County East Side Edgar County Effingham County Egyptian Evanston Fayette County Ford County Franklin-Williamson Fulton County Greene County Grundy County Hamilton County Hancock County Henderson County Henry County Iroquois County Jackson County Jasper County Jefferson County Jersey County Jo Daviess County Kane County Kankakee County Kendall County Knox County Lake County LaSalle County Lawrence County Lee County Livingston County Logan County Macon County Macoupin County Madison County Marion County Marshall County Mason County McDonough County McHenry County McLean County Menard County Mercer County Monroe County Montgomery County Morgan County Moultrie County Oak Park Ogle County Peoria City/County Perry County Pike County Putnam County Randolph County Rock Island County Sangamon County Schuyler County Scott County Shelby County Village of Skokie Southern Seven St. Clair County Stark County Stephenson County Stickney Township Tazewell County Vermilion County Wabash County Warren County Washington County Wayne County Whiteside County Will County Winnebago County Woodford County Other
Employer:
Occupation:
Please briefly describe the concern or delay you are experiencing related to the vaccine:
Illinois Department of Human ServicesJB Pritzker, Governor · Grace B. Hou, Secretary
IDHS Office Locator
IDHS Help Line 1-800-843-6154 1-866-324-5553 TTY
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