Thank you for your interest in receiving the COVID-19 Vaccine.  Southwest Health & Human services covers the Minnesota counties of: Lincoln, Lyon, Murray, Pipestone, Redwood and Rock.  This survey will not be able to provide WHEN you will receive the vaccine, but this survey will collect information so you can be contacted when you are eligible to receive the vaccine. The different groups are categorized by the Minnesota Department of Health in conjunction with the Centers for Disease Control.

Minnesota is still working with a limited supply of vaccine.  When you are able to receive the vaccine will depend largely on how much vaccine the manufacturers are able to make and send out, and how many people get vaccinated in the previous priority groups. It is very likely that others in different parts of the state and country are vaccinated at different times.  People do not need to make an appointment at this time. We are working on getting the vaccine out as quickly and as safely as possible.

This survey is NOT intended for those under the age of 18 or who do NOT live or work in Lincoln, Lyon, Murray, Pipestone, Redwood or Rock counties.  If you have specific medical questions, please contact your medical provider.

Currently we are vaccinating with Moderna COVID-19 Vaccine.  This vaccine is a two dose series, separated by 28 days. 

Click on the link for more information about the Moderna Vaccine.
https://www.modernatx.com/covid19vaccine-eua/eua-fact-sheet-recipients.pdf

Keep protecting yourself and others and stay vigilant; we still need to wear masks, stay six feet away from others, and avoid high-risk situations that might cause the virus to spread until we know for sure that most Minnesotans are protected.

Southwest Health & Human Services is collecting the following information to assist with planning  vaccinations for the COVID-19 virus. The information you are providing will assist us in that effort. Your information will be used to determine when you may be eligible for the vaccine and for us to contact you when you are eligible to receive the vaccine. This information will be used only for that purpose and will be used only by employees of SWHHS and other local vaccine providers. You do not have to provide all of this information but if you do not, your ability to access these services may be impacted. 


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* 1. What is your last name?

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* 2. What is your first name?

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* 3. What is your address?

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* 5. How old are you (in years)?

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* 6. What is your cell phone number?

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* 7. What is your home phone number?

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* 8. What is your email address?

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* 9. Will you need an interpreter?

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* 10. What category best describes you (check all that apply)?

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* 11. If you checked "Frontline essential worker", please list your employer and the location of the business.

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* 12. If you checked "Phase 1A Healthcare worker", please list your employer and your title.

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