COVID-19 IMMUNIZATION

Due to limited supply of COVID-19 Vaccine, you may not get contacted immediately.  We will reach out to you as quickly as possible via phone and/or email.  All inquiries are handled in the order they are received and by population priority.  Thank you for your patience! 

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* 1. If you are an individual and not a facility seeking multiple vaccinations (facilities skip to Question #2), then please answer the following questions to have someone contact you about making an appointment to receive your COVID-19 vaccine. 

If filling out this portion, then please skip to Question #3 when completed.

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* 2. If you are working with a healthcare facility, EMS, home healthcare, outpatient facility, pharmacy, shelter home, long term care facility, jail, or other (after death care of COVID infected, other type of healthcare setting, ect.) and needing to have staff vaccinated then please fill out the following (IF FILLING OUT THIS PORTION YOU WILL NOT NEED TO ANSWER ANY FURTHER QUESTIONS):

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* 3. What is your age group?

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* 4. Do you have one or more of the following conditions from the below mentioned list?
- Cancer
- Chronic Kidney Disease
- COPD (Chronic Obstructive Pulmonary Disease)
- Heart Conditions (Heart Failure, Coronary Artery Disease, or Cardiomyopathy)
- Solid Organ Transplantation
- Obesity and Severe Obesity (Body Mass Index of 30 kg/m^2 or Higher)
- Pregnancy
- Sickle Cell Disease
- Type 2 Diabetes Mellitus

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* 5. Have you already received a 1st dose of the vaccine and are looking to get your second dose? 

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