Coronavirus Vaccine Signup

Thank you for registering for our waiting list to receive the COVID-19 vaccine.

Please do not call the hospital or any of our clinics to confirm or see where you are on the list.

You will be contacted by a member of our hospital staff at the phone number provided on this form when you have been scheduled for an upcoming vaccine clinic. Please make sure the contact number provided is accurate.
Currently we are following the IDPH’s COVID-19 Vaccination Plan and vaccinating those individuals included in Phase 1a and Phase 1b. For more information about Illinois’ COVID-19 vaccination efforts please visit: https://coronavirus.illinois.gov/s/
At this time, we are at the mercy of the State of Illinois as to WHEN and HOW MANY vaccines we will receive. Priority will be given to assure those receiving the first shot will be scheduled to receive the second dose. We estimate it could take several months to vaccinate this group of the population.

We cannot guarantee vaccination by being put on this list. If you have another opportunity to receive the vaccination, we suggest you take advantage of that opportunity.

We ask for your patience and understanding as we work hard to vaccinate our community. Thank you!

This confirms your registration to be put on a wait list to receive the COVID-19 vaccine at Pana Community Hospital.

It is not a guarantee of vaccination. You will be contacted by a member of our hospital staff at the phone number provided on this form when you have been scheduled to receive the vaccine.
Vaccinations are by appointment ONLY and no walk in clinics will be offered at this time.

Please be patient, as our demand far exceeds the vaccine availability at this time. Our staff members are unable to provide you with additional information about where you are on the list, or what date you will be vaccinated, because we do not know that information. Our clinics are scheduled on the Tuesday following our receipt of the vaccine, and you will be called at the number provided. Please know that we are doing our very best to vaccinate our patients as quickly as we can.

Thank you for your understanding and patience.

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