Complete this form for each person in your home who is age 65+. After you complete this form, you will be on a COVID-19 vaccination request list with public health. Our staff will then call or email you to make sure you can receive the vaccine and schedule appointments as our supply permits. We kindly ask you to wait for our call rather than calling our office. This will help keep our precious phone lines open to make appointments. If you receive vaccination elsewhere, please share this information with our scheduling staff when they contact you so we can remove you from this list.
If you know someone who needs help filling out this form because they do not have a smart phone or internet access, assist them with completing this form or have them call 507-765-2601. Staff are available at this number Tuesday through Thursday from 9 AM to 3 PM.
Please continue to follow face covering, hand washing, and social distancing recommendations. Stay safe and be well!
Special Notice: Completing a vaccination request form does not guarantee immediate appointment scheduling or vaccination. Some individuals may not be able to receive vaccination due to their specific health needs.
System Maintenance Notice: Periodically, we may need to close this registration site to conduct upgrades or manage the list. During business hours, you may call 507-765-3898 to report site outages lasting more than two hours. Thanks!
