Local supply is currently limited and vaccine administration is based on state guidance which can be found on the Department of State Health Services website.

Please enter your contact information in order to be notified when COVID-19 vaccines are available.
This form will serve as a contact list to be used by the Brownwood/Brown County Health Department when there are vaccines available for qualifying groups. The Health Department may share this list with local providers who have vaccines in order to expedite vaccine distribution.

DISCLAIMER: Submitting information on the contact form does not guarantee a person and/or organization vaccines nor does it place individuals in a “queue”. Additionally, repeated submissions and calls inhibit our ability to respond in a timely manner. Please only submit when appropriate and only submit one per person/organization.

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* 1. Please enter your last name

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* 2. Please enter your first name

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* 3. What is your date of birth?

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* 4. How old are you?

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* 5. Please enter your email address

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* 6. Please confirm your email address

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* 7. Please enter your telephone number

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* 8. Please enter your physical address (not a PO Box)

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* 9. Are you a first responder or medical professional?

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* 10. If you answered "yes" where are you employed?

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* 11. Do you have a chronic health condition such as (but not limited to) cancer, chronic kidney disease, COPD (chronic obstructive pulmonary disease), heart conditions (heart failure, coronary artery disease, or cardiomyopathies), solid organ transplant, obesity, pregnancy, sickle cell disease, type 2 diabetes mellitus?

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* 12. Have you received a vaccination within the last 14 days?

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* 13. If you answered "yes" which vaccine did you recieve?

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* 14. Have you had COVID-19?

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