Vaccine Interest Form - Hunt County
This form is to express your interest in receiving the COVID-19 vaccine in Hunt County.

Please make sure the information you enter is correct. You will not be able to change the information after you hit submit. Once submitted you will see a confirmation page for your form submission.

Complete the form for each person interested in receiving the vaccine, however, do not sign up the same person more than once.

Please know that completing this form does not guarantee an appointment to receive the vaccine. Any appointment will be confirmed later via email or phone.
Email address *
Confirm Email *
First Name *
Last Name *
Phone # *
Street Address *
City *
State *
2 Digit State Code, example: TX, LA, OK
Zip Code *
Are you over 65 years of age? *
Date of Birth *
MM
/
DD
/
YYYY
Are part of the Phase 1A Vaccine Group? *
Are you part of the Phase 1B Vaccine Group? *
Are you part of the eligible school and child care worker vaccine group? *
Submit
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