At this time, this survey is only for those 65 years of age and older that live in Jefferson County. 

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* 1. Last Name

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* 2. First Name

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* 3. Age (You will be asked to bring some kind of ID to verify your Date of Birth)

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* 4. If offered, would you get the COVID-19 Vaccine from the Jefferson County Health Department?

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* 5. Telephone Number

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* 6. Email Address (please use whichever you check most frequently)

*Please note that this survey does not guarantee anyone an appointment time or vaccine. This simply denotes your interest to the Jefferson County Health Department in receiving a vaccine.*

There are ~10,000 people in Jefferson County who are now eligible, but the amount of vaccine is very limited.  We are excited to vaccinate as many people who are interested as we can, but it's important to remember that it will take time to get through everyone.
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