This form is for employees of UT Health San Antonio to request an appointment for COVID-19 vaccination for their family members. Vaccine recipients must be 16 years of age or older.

When you submit this form, a confirmation email will be sent to the email address you enter for your family member.

Within 24 hours, your family member will receive a second email with instructions to schedule their vaccine appointment.

Those emails will be sent from the address UT_HEALTH_DoNotReply@uthscsa.edu -- make sure they watch out for emails from that address.

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