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COVID Vaccine Request Form

We are offering employees of Georgian Court University the opportunity to request a COVID vaccine through Chemed located in Lakewood. As a member of the faculty/staff you will be eligible to get the vaccine on April 5, 2021. If you would to sign up for one, please fill out the form below. Please note all vaccines will be given at their site in Lakewood and that they cannot accommodate preference for one vaccine over another.

After you fill out the form and submit it, you must also pre-register on the Chemed Portal to complete the process.

Registration at CHEMED:
Go to Chemedhealth.org
Click Patient Portal in top right corner (not COVID links)
In blue box, click pre-register
Complete information

Chemed will contact you directly to schedule an appointment based on their vaccine supply.

The COVID Vaccine Request form is no longer available.