Sign Up for the Lifespan Community COVID Vaccination Program

Lifespan is working closely with the Rhode Island Department of Health to administer COVID vaccines, consistent with state guidelines on vaccine distribution. Please provide the following information if you are interested in receiving both doses of a coronavirus vaccine from a Lifespan provider. 

This form is only an expression of interest, not a registration. Once you submit this form, you will be called within 3 business days to complete the registration process, in accordance with the Rhode Island Department of Health’s vaccine eligibility criteria. 

After submission, you do not need to call Lifespan to register for the vaccine. Please do not submit this form if you already have an appointment to receive the vaccine at a Lifespan facility or elsewhere. 

Thank you for your patience as we work to vaccinate eligible patients as safely and quickly as possible.

Please use the form below to sign up for the program.

Forms will be sent to the Lifespan vaccine team for processing.