65+  Vaccine Interest Survey

Watonwan County Public Health is identifying individuals who are eligible and interested in receiving the COVID-19 vaccine. 

The Governor announced an expansion to allow for vaccination of individuals who are over the age of 65 and those working in schools and childcare. This survey identifies that you or your eligible family member is interested in receiving the COVID-19 vaccine with our next priority group when we have additional vaccine. We will provide information on how you can schedule your vaccine appointment when we receive additional doses of vaccine through multiple formats including your contact information in this survey. Please continue to follow our Facebook page and check our COVID-19 tab on our webpage. 

https://www.facebook.com/WatonwanCountyPublicHealth 

https://www.co.watonwan.mn.us/

If you are completing the survey on behalf of an eligible family member or friend please enter in their information below

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* 1. Do you live in Watonwan County?

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* 2. Eligibility Criteria

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* 3. First Name

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* 4. Last Name

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* 5. Phone Number

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* 6. Email

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* 7. Address

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* 8. How old are you?

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* 9. What is your date of birth? (month/day/year)

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* 10. Do you need a Spanish interpreter?

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* 11. Do you have a pre-existing medical condition?

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* 12. Do you currently use a walker, cane, or wheelchair?

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* 13. Do you need personal assistance with mobility?

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* 14. Do you have access to transportation to attend a local COVID-19 vaccine clinic?

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* 15. Who is your primary care provider?

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