Clermont County Public Health is collecting information from Clermont County residents that fall into priority group 1B who would like to be put on the waiting list to get the COVID-19 vaccine. Completing this survey does not mean you are scheduled to get the vaccine. If you complete the survey and are eligible to get vaccinated, we will contact you with further instructions.

Priority Group 1B consists of adults over the age of 65 and people with severe, congenital, developmental or early-onset medical disorders. Adults over the age of 65 will be prioritized beginning with people who are 80 years of age and older.

If you are a K-12 school staff member, please don't fill out the survey. We will be working with your school to schedule a vaccine clinic.

Please be patient and only fill out the survey one time. As more vaccine is available we will contact you with options for vaccination.

If you do not live in Clermont County, please use this link to contact your local health department 

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* 1. Are you registering yourself or someone else?

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* 2. What is the name of the person wishing to receive the vaccine?

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* 3. What is your name (if registering someone else)?

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* 4. Age of person to be vaccinated?

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* 5. Does the person to be vaccinated live in Clermont County?

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* 6. What is the address of the person to be vaccinated?

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* 7. How can we contact you?

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* 8. Additional Information

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