This survey is for individuals who are living in Sacramento County who are 65 years or older.

Please complete the survey below if you wish to be emailed about future Sacramento County hosted COVID-19 vaccination clinics. We also encourage you to reach out to your health care provider for additional information regarding how to receive your COVID-19 vaccine. 

If you are aged 65 and older and a resident of a neighboring county, please check with your county of residence for vaccine eligibility and clinic offerings:

Amador County

Contra Costa County

El Dorado County

Placer County

San Joaquin County

Solano County

Sutter County

Yolo County

*Registration is through Survey Monkey directly to Sacramento County Public Health staff. Sacramento County does not exercise any editorial control over additional surveys Survey Monkey may provide.

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* 1. First Name

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* 2. Last Name

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* 3. County of Residence

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* 4. Email Address

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* 5. Phone Number

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* 6. Age

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* 7. Please list any underlying health condition that you are diagnosed with:

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