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Warren County Health Department COVID-19 Vaccine Eligibility & Pre-Registration

The State of Missouri is conducting a phased roll-out of the COVID-19 vaccine based on priority. The following form will gather information about you, including your health and employment to determine your eligibility in order to register you to receive an appropriate vaccine appointment when vaccine is available in Warren County.

We ask that you answer truthfully in order for us to be able to distribute the vaccine as effectively as possible. All your information will be kept confidential to the extent allowed by law. At this time we have the MODERNA vaccine. That is subject to change at any given clinic depending on what is shipped to us from the federal government.

In continuing this survey, you imply consent to participate in the Warren County Health Department Vaccine Eligibility & Pre-Registration Survey.

Question Title

* 1. Have you previously received a FIRST dose of the COVID-19 vaccine?

If you previously received a first dose of any COVID-19 vaccine through a primary care provider, hospital or pharmacy or other provider you will need to schedule your second dose through the same organization. At this time we are not able to schedule appointments for those who have already received their first dose. This ensures that you are provided the correct second-dose and that the vaccines can be distributed as efficiently as possible across the state. Thank you!

Yes