By completing this survey, you agree to the following: (a) you are a member of the Sault Ste. Marie Tribe of Chippewa Indians and/or a Sault Tribe Team Member OR you are a non-native spouse of a Sault Tribe member OR non-native family member of a Sault Tribe member; or (b) you are a member of a Federally recognized tribe; and (c) you are 16 years of age or older; and (d) that you are interested in receiving a COVID-19 vaccination.  The COVID-19 vaccination is very limited at this time.  All appointment dates and times will be scheduled as the vaccination becomes available.  

The purpose of this survey is to provide information that you are interested in receiving a COVID-19 vaccination.  This survey is being conducted by the Sault Tribe Health Division (STHD) through Survey Monkey.  Your participation in this survey is voluntary.  If you do not wish to receive a COVID-19 vaccination then you may choose not to complete this survey.  Appointments will only be scheduled for individuals who have completed this online registration.  
 
 
Your responses will be confidential, and any information provided will be kept within the STHD.  We will do our best to keep your information confidential.  All data is stored in a password protected electronic format.
 
By completing this survey, you are agreeing to disclose all information contained in it with the STHD and to be contacted about future COVID-19 vaccination opportunities.  If you have any questions or concerns about the survey, please contact the STHD.

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* 1. Patient First and Last Name

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* 2. Date of Birth    {EX: (01/01/1901}

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* 3. Phone Number {EX: (906)632-5200 }

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* 4. Email Address

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* 5. Street Address

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. Site Preference:

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* 10. Please provide any comments or feedback below:

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