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COVID-19 Vaccine Interest Form

If you would like us to advise you of the availability of the COVID-19 vaccine when it is made available to the public, please provide the following information:

  • Adults of any age with the following conditions are at increased risk of severe illness from the virus that causes COVID-19.
  • Based on what we know at this time, adults of any age with the following conditions might be at an increased risk for severe illness from the virus that causes COVID-19.

For information on this and actions that you can take to keep yourself safe, visit the CDC website.