The Miami County Health Department is following vaccine recommendations from the Centers for Disease Control and Prevention and the Kansas Department of Health and Environment.

By completing this form, your healthcare practice/organization is indicating you would like to be contacted by Miami County Health Department if COVID-19 vaccine becomes available. This does not guarantee your practice/organization will receive the vaccine from Miami County Health Department. If you are able to obtain the vaccine from another provider or need to change the number of doses requested in Miami County, contact us so you can be removed from this list, or so we can make an addendum. 

Questions? Please contact Miami County Health Department at 913-294-2431 or by email at: cbeer@miamicountyks.org 

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* 1. Name of Organization

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* 3. Number of Staff/Volunteers to be vaccinated

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* 4. Name, phone number and email for contact

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