COVID-19 Vaccine Form

Read qualifications for requesting COVID-19 Vaccine from WHS.

Please read the following before requesting an appointment to receive the COVID-19 Vaccine.

Washington Health System (WHS) is currently administering vaccines to those that fall in the Phase 1A category that also live in Washington or Greene County or are a patient of a WHS practice. This includes individuals that are 65 and older and those that are 16-64 with one of the preexisting conditions below.

High-risk conditions that qualify for a vaccine under Phase 1A:

  • Cancer
  • Chronic kidney disease
  • COPD
  • Down Syndrome
  • Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Immunocompromised state (weakened immune system) from solid organ transplant or from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
  • Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
  • Severe Obesity (BMI ≥ 40 kg/m2)
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Diabetes

To request an appointment to receive the vaccine, please complete the form linked below. Please do not fill in this form if you do not qualify under the 1A category. We will not keep a list of those that fall within other categories.

By submitting this form you attest that you qualify for the vaccine within Phase 1A and are agreeing to show up to your scheduled appointment.

Request Appointment

Please remember to be patient through this process. WHS received over 15,000 vaccinations requests within the first 48 hours. We have a team reviewing all requests to confirm eligibility, and therefore it could take up to several days to receive an initial confirmation reply.  Please do not submit a duplicate registration or call the hospital with questions pertaining to vaccination registration as this only slows the process.

If several days have passed and you are still waiting for an e-mail confirming the receipt of your registration please try searching your junk/spam e-mail folder for an e-mail from whs. 

For more information from WHS about COVID-19 response, click here.

Additional Information

Current Location: NOTE you must have an appointment for all locations.

WHS Washington Hospital   
Park in visitors parking and enter through the 2nd floor main entrance
155 Wilson Ave,
Washington PA 15301

More Locations coming soon:

WHS Greene – Starting 2/15/2021 Wellness Center Entrance – Lower Level 350 Bonar Ave, Waynesburg, PA 15370

Washington Crown Center – Starting 2/18/2021 The Old Ross Location 1500 W Chestnut St, Washington, PA 15301

Peters Township Community Recreation Center – Starting 2/22/2021 Side Entrance – Follow Signs 700 Meredith Dr, Venetia, PA 15367

  • A scheduled appointment, no walk-ins accepted
  • Your driver’s license or other government-issued photo ID
  • A mask to wear while maintaining social distancing and safety guidelines
  • Clothing that will allow unrestricted access to your shoulder and upper arm to administer your COVID-19 vaccine
  • Insurance is NOT required to get a vaccine and there will be no charges or copays to the vaccine recipient.
  • If you require reading glasses, please bring those with you so that you can complete your consent form. Or, click here to print your consent form ahead of time, fill it out at home, and bring it with you to your appointment.

If you need to cancel your appointment , you can do so here: Appointment Cancellation Form.

We will not be able to administer your vaccine if any of these conditions apply on the day of your appointment:

  • If you have experienced any flu or COVID symptoms in the past 48 hours
  • If, within the past 14 days, you have been in close physical contact (six feet or closer for a cumulative total of 15 minutes) with someone who has confirmed COVID-19.
  • If you are isolating or quarantining because you may have been exposed to a person with COVID-19 or are worried that you may be sick with COVID-19.
  • If you are currently waiting on the results of a COVID-19 test.

Please be sure to cancel your appointment if any of these conditions arise.



The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and never disregard professional medical advice or delay in seeking it because of something you have read on this website.