COVID Vaccine Pre-registration

Oneida County Government is working to deliver vaccine to our residents. The purpose of this form is to gather information from residents about their interest in receiving COVID-19 vaccination. We will ask some questions to determine when you are able to get the COVID-19 vaccine. The information entered on this form will be kept confidential and will only be used to connect you with where you can register to receive a COVID-19 vaccine in the future. We will communicate with you directly as appointments become available.
Please enter the contact information for the registrant.(Required.)
Please enter your date of birth.(Required.)
Date
Please enter your cell phone number(Required.)
Please enter a landline phone number (optional)
Are you the person being pre-registered?(Required.)