Lafayette County Health Department COVID-19 Vaccine Sign-up
This does not guarantee you an appointment or confirm your request. Further communication will come as details are available to the Lafayette County Health Department
Email address *
First name *
Last name *
Date of Birth *
Phone Number *
Lafayette County County of Residence *
Occupation *
Name of Employer *
Do you have any underlying health conditions? *
Are you currently on any other vaccine waitlists? *
A copy of your responses will be emailed to the address you provided.
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