Name: | DOB: | MRN: | PCP:

BlueQueue MRN Request

This form is for University of Michigan Personnel only. At this time, we are only vaccinating U of M Personnel and established Michigan Medicine patients. Please refer to https://www.uofmhealth.org/coronavirus/vaccine-info-update for additional information.

IMPORTANT:

For University of Michigan Personnel, you will receive an activation link via email once your medical record number is created.
Please monitor your email account for an activation link to the MyUofMHealth Patient Portal.
The activation link is only active for 24 hours and if not used will deactivate.

Have you received an invitation from BlueQueue to schedule an appointment yet?
Are you UM personnel?