Vaccine pre-registration Saturday, October 10

Vaccine pre-registration Saturday, October 10
Pre-register now so your visit at the clinic is quick. This takes about two minutes.

You will need:
- Your date of birth
- A phone number where we can reach you
- Your insurance card, if you have one
Pre-registration does not reserve an appointment time. It saves you from filling out paperwork when you arrive
Your Name

First NameLast Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearWe use this to match you to your MultiCare record.
Phone Number
Please enter a valid phone number. We will text or call only if we need to confirm something about your registration.Format: (000) 000-0000.
Most vaccines are covered at no cost to you. A photo of your card helps us bill your plan correctly and speeds up check-in. The back of the card includes the claims and pharmacy information we need.
Insurance card, front
Insurance card, back
No insurance
By submitting this form you agree that MultiCare may use the information you provide to prepare for your visit and to bill your insurance. Your information is protected under our privacy practices and is not used for marketing.
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