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  with information on vaccine clinics in your area. 

Anyone over the age of 16 is eligible to receive a vaccine.  Some vaccines are only approved for people 18 years of age or older.  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.  Continue to follow MDH/CDC guidelines regarding COVID-19.

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 contact with information regarding vaccine availability. 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 date of birth?

Date

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* 7. What is your cell phone number?

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* 8. What is your home phone number?

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* 9. What is your email address?

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* 10. Will you need an interpreter?

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