COVID-19 Vaccine Pre-Registration
Because vaccine supplies are limited, Wyoming is currently only pre-registering people 65 and older and those with certain medical conditions. Completing this form does not create a vaccine appointment, and does not mean you will have immediate access to the vaccine.

You will remain on the registry until you are selected for an appointment.

Please do not use this form if:
- You have already received your first dose of COVID-19 vaccine. You will receive information about your second dose from the healthcare entity that administered your first dose.
- You have already been placed on a waitlist through your local health department or other healthcare provider.
I, the interested party, confirm that I have read or been told the above information. *
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