Covid Vaccine Registration


Available to residents of Wharton and Matagorda County. Others will be placed on a waiting list.
You will be contacted for an appointment. If you receive an appointment and do not attend, you will not be allowed to reschedule.

Please be prepared to show Photo I.D.

Complete the following information as accurately as possible. This form should take 4 or 5 minutes to complete. To submit your information simply click the "Submit Form" button to complete your registration process. (*) Required information is necessary.

Name(Required)
Sex(Required)
Race(Required)
Ethnicity(Required)
Address(Required)
MM slash DD slash YYYY

Medical History

Please select all that apply.
Age 65 or Older(Required)
Do you currently have:(Required)
Check all that apply.
Are you Pregnant?(Required)
Please enter your name.
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.
El Campo Memorial Hospital (ECMH) and its predecessor have been providing the highest quality medical care in El Campo for over 68 years, and at the current location since 1979.The hospital is accredited by state and federal regulations (Medicare/Medicaid). Patient Billing: Various physicians involved in your care at ECMH will bill you directly for their services. These may include your anesthesiologist, emergency room physician(s), radiologist, pathologist, cardiologist or other consulting physician during your ER visit or hospital stay. Please remember that some physicians are private practitioners (contracted by ECMH and not an actual employee of ECMH) and may not be a provider on your specific managed care plan.