COVID-19 Vaccine

Prism Health North Texas & Uptown Physicians Group

COVID-19 Vaccine Information & Instructions

COVID-19 Vaccine doses are limited to current Prism Health North Texas and Uptown Physicians Group patients and must be in one of the following groups:

• Phase 1A – First responders
• Phase 1B – People 65 years of age or older

Vaccine Request Instructions

NOTE: Receipt of paperwork by either Prism Health North Texas or Uptown Physicians Group does NOT guarantee you will receive the vaccine. Both Prism Health North Texas and Uptown Physicians Group are not guaranteed shipment of vaccine doses each week, and both will do their best to get vaccines weekly as the state allows.

Step 1: Fill out Pre-Vaccination Checklist and the Texas Immunization Registry Adult Consent Form – Click Here to Download Forms

Step 2: Submit completed forms (Indicate in the email if you are a Phase 1A – First Responder or part of Phase 1B group.)

• Prism Health North Texas Patients – Email forms to [email protected]
• Uptown Physicians Group Patients – You can either fax the completed forms to 214-303-1032, attach them to a portal message, or email the forms to [email protected]

What to Expect After You Submit Your Request: Your paperwork will be entered into the system. If you are able to receive a vaccine, you will be contacted by your provider’s office to set up an appointment for vaccination.