Demographic Information

First of all, thank you for visiting this survey and signing up to take the vaccine. Vaccines only work when people are willing to be vaccinated. This survey will not be able to provide WHEN you will receive the vaccine, but this survey will collect your information so you can be contacted when the 'Phase' you are in will be vaccinated. The 'Phases' were designed by our parent federal and state partners. 

At this time, we are still vaccinating healthcare workers and assisted living residents. The groups that will come after these first groups are frontline essential workers and adults 75 years and older for phase 1b. For phase 1c, adults ages 65-74 years, people ages 16 to 64 years with high-risk medical conditions, and other essential workers will be able to get vaccinated. We do not yet know when people in phase 1b and 1c will be able to get the vaccine in Minnesota. This will depend on how much vaccine the manufacturers are able to make and send out, and how many people get vaccinated in the first priority groups. People do not need to make an appointment at this time. Updates will be provided when we are able to start vaccinating more people and we will provide more information at that time for how eligible people can get vaccinated.

Here at the Des Moines Valley Health and Human Services (DVHHS), your health and wellbeing matter to us! We have been partnering and collaborating with health care, schools, pharmacies, long term care providers, and our local emergency services, to name a few, to design the rollout of the vaccine. This survey is intended to capture the 16,000 people who live in the counties of Cottonwood and Jackson, and who are over the age of 18. This survey is NOT intended for those under the age of 18 or who do NOT live in Jackson and Cottonwood counties. 

If you don't live in Cottonwood or Jackson, but work in our counties, you MAY be offered the vaccine through work, but should consult with your county and employer to obtain the vaccine. This survey is not intended for those individuals.

Again, thank you... DVHHS

Des Moines Valley Health and Human Services (DVHHS) is collecting the following information to assist with planning around 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 DVHHS. 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. Which county do you live in?

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* 2. Are you filling this out for someone under the age of 18, or are you 18 or younger?

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* 3. What year were you born?

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* 4. What city do you live closest to?

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* 5. Which town do you live in?

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* 6. What is your first name?

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* 7. What is your last name?

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* 8. What is your phone number (numbers only)?

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* 9. It may be easier to contact you via email. What is your email address (if you have one)?

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* 10. Have you already had the vaccine shot?

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* 11. Has your employer contacted you about your interest in the vaccine?

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* 12. Will you need an interpreter?

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* 13. Are you filling this survey out for someone else other than yourself?

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