COVID-19 Vaccine Registration

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sXeeBi8xhPyFgB5FSfqGT9HGp3H9hw6huSIsxYUfomyxC5jh6PkDTF62bCaPcx4cRxwCgJvW4GCRc7Tj6F

COVID-19 Vaccine Registration for Texas Residents

M-D-Y

Thank you for your interest in receiving a COVID-19 vaccine at UT Southwestern.

We have briefly paused registration so that we may efficiently vaccinate eligible individuals on our list thus far. We want to provide assurance to all those who sign up that they are not just a number in a growing list and will be vaccinated within a two to three-week window.

Our registration will continuously open and close to reflect the amount of vaccine we expect to receive from the State in the coming week. Please check back every Monday morning.

Return to the COVID-19 Vaccination webpage.

Gracias por su interés en recibir una vacuna contra el COVID-19 en UT Southwestern.

Hemos alcanzado nuestro límite actual de inscripciones y pararemos brevemente de aceptar nuevas. Haciendo esto también brinda a las personas elegibles que acaban de inscribirse la seguridad de que serán vacunadas en un plazo de dos a tres semanas.

Por favor vuelva a revisar el lunes 8 de febrero entre las 8 a.m. y el mediodía, ya que reabriremos la inscripción una vez que administremos nuestro más reciente envío de vacunas y recibamos dosis adicionales. Esa cronología podría cambiar si recibimos vacunas adicionales o si hay algún retraso en nuestros envíos. Agradecemos su paciencia durante este tiempo altamente dinámico.

We are working hard to ensure all those who wish to be vaccinated have the opportunity.

Unfortunately, the demand for vaccine remains far greater than the supply.

At this time, if you are a member of Phase 1B or have a medical condition outlined by the U.S. Centers for Disease Control and Prevention as carrying increased risk for severe illness from COVID-19, you are eligible for vaccination.

If you meet the criteria, are a Texas resident, and are not yet registered as a UT Southwestern patient in MyChart, please complete the short questionnaire below so that we may take the next step toward your vaccination.

Inscripción de la Vacuna Contra el COVID-19 para las personas que viven en el estado de Texas

Estamos trabajando duro para asegurar que todos aquellos que desean vacunarse tengan la oportunidad.

Desafortunadamente, la demanda de vacunas sigue siendo mucho mayor que el suministro.

En este momento, si usted es miembro de la Fase 1B o tiene una condición médica descrita por los Centros para el Control y la Prevención de Enfermedades de EE.UU. que conlleva un mayor riesgo de enfermedad severa por COVID-19, es elegible para una vacuna.

Si cumple con los criterios, vive en el estado de Texas y aún no está inscrito como paciente de UT Southwestern en MyChart, por favor complete el siguiente cuestionario para poder continuar con el proceso de registro para la vacuna..

Your email address and confirmation email address do not match.

Su dirección de correo electrónico y la dirección de correo electrónico de confirmación no coinciden.

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M-D-Y

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You are not eligible to receive the COVID-19 Vaccine yet based on your age.

Basado en su edad, aún no es elegible para recibir la vacuna contra el COVID-19.

Please recheck your date of birth.

Por favor revise de nuevo su fecha de nacimiento.

Female/Femenino

Male/Masculino

Other/Otro

reset

Asthma/Asma

Cancer/Cáncer

Chronic kidney disease/Enfermedad renal crónica

Chronic obstructive pulmonary disease (COPD) or emphysema/Enfermedad pulmonar obstructiva crónica (EPOC) o enfisema

Cystic fibrosis/Fibrosis quística

Dementia or other neurologic conditions/Demencia u otras condiciones neurológicas

Diabetes mellitus/Diabetes mellitus

Down syndrome/Síndrome de Down

Hypertension or high blood pressure/Hipertensión o presión arterial alta

Immune-compromised (any disease that impacts immune system)/Inmunocomprometido (cualquier enfermedad que afecte el sistema inmunológico)

Liver disease/Enfermedad del hígado

Obesity and severe obesity (body mass index of 30 kg/m2 or higher/Obesidad y obesidad severa (índice de masa corporal de 30 kg/m2 o más alto)

Pregnancy (current)/Embarazo (actual)

Pulmonary fibrosis (scarring of lung tissues)/Fibrosis pulmonar (cicatrización de los tejidos pulmonares)

Serious heart disease, such as heart artery disease, congestive heart failure, cardiomyopathy, heart valve disease, or congenital heart disease/Enfermedad cardíaca grave, tal como enfermedad de las arterias cardíacas, insuficiencia cardíaca congestiva, cardiomiopatía, enfermedad de las válvulas cardíacas, o cardiopatía congénita

Sickle cell disease/Enfermedad drepanocítica

Solid organ transplant recipient (kidney, liver, pancreas, lung, or heart transplant)/Receptor de trasplante de órgano sólido (trasplante de riñón, hígado, páncreas, pulmón, o corazón)

Stroke or cerebrovascular disease/Derrame cerebral o enfermedad cerebrovascular

Thalassemia (a type of blood disorder)/Talasemia (un tipo de trastorno sanguíneo)

Based on your responses, you are not yet eligible to receive a COVID-19 vaccine at UT Southwestern. Current eligibility criteria can be found on our COVID-19 Vaccination website.

De acuerdo con sus respuestas, todavía no es elegible para recibir una vacuna contra el COVID-19 en UT Southwestern. Los criterios de elegibilidad actuales se pueden encontrar en nuestro sitio web de vacunación COVID-19.

Press "Submit" to complete your registration.

Due to heavy traffic, it may take up to sixty seconds for your registration to complete. Please only press submit once.

Please do not submit your registration until you have filled out this form completely and accurately.

Presione “Enviar” ("Submit") para completar su registro.

Por favor, no presente su formulario de registro hasta llenar la información completa y adecuadamente.

Debido a la cantidad de solicitudes, el proceso de registro puede tomar hasta 60 segundos. Por favor presione “enviar” solamente una vez.

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HIDDEN FIELD: Intro Text (Shows at top, gets removed manually when entries > 10,000)

COVID-19 Vaccine Registration

We are working hard to ensure all those who wish to be vaccinated have the opportunity.

Unfortunately, the demand for vaccine remains far greater than the supply.

At this time, if you are a member of Phase 1A or 1B or have a medical condition outlined by the U.S. Centers for Disease Control and Prevention as carrying increased risk for severe illness from COVID-19, you are eligible for vaccination.

If you meet the criteria and are not yet registered as a UT Southwestern patient in MyChart, please complete the short questionnaire below so that we may take the next step toward your vaccination.

Awaiting Spanish Translations.

HIDDEN FIELD: "Thank you" text (after submission, participant sees:)

Thank you for your interest in receiving a COVID-19 vaccine at UT Southwestern.

If you meet the current eligibility requirements for vaccination, you will be sent an activation code for MyChart where you can begin searching for available appointments. Please look for an email from mychart@utsouthwestern.edu in about three days. You may need to check your spam folder.

We look forward to the opportunity to vaccinate you and appreciate your patience during this highly dynamic time.

Return to the COVID-19 Vaccination webpage.

HIDDEN FIELD: redirect email:

https://utswmed.org/covid-19/covid-19-vaccination/

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.