Request Appointment

A representative will contact you within one business day to set up your appointment. If this is an emergency, call 911 or go to your nearest ER.

COVID-19 Vaccine

All our appointment times for vaccination have been filled at this point. We will let the public know when we receive more vaccines. Wellington Regional Medical Center continues to follow the federal and state vaccination guidelines.

NOTE: With this form, you are submitting a request for appointment. A representative will contact you once an appointment has been secured or, if necessary, to discuss alternative options.

Appointment Information

Reason for Appointment *

When are you available for an appointment *

Insurance Information

Insurance Provider

Member ID#

Group Number

Current PCP

Contact Information

First Name *

Last Name *

Date of Birth (MM/DD/YYYY) *

Phone Number *

Email *

Street Address *

City *

State *

Zip Code *

General Comments

E.g. willing to see a different provider in order to match any preferred availability

What led you to our website? *

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Request Appointment

COVID-19 Vaccine