Nicollet County COVID-19 Vaccine Survey for Residents Ages 65 and Older
Nicollet County Health and Human Services hopes to begin providing vaccine for the 65 and older population in the near future. Currently, our vaccine allocations remain very limited. Please complete this survey only if interested in receiving the COVID-19 vaccine. Completing the survey indicates that you are interested in the vaccine and ensures that we can contact you for registration purposes when vaccine opportunities are available. This survey is only for individuals who live in Nicollet County and are ages 65 and older. Contact information for individuals not meeting this criteria will not be used.
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First Name *
Last Name *
Email address that can be used for registration: (indicate none if you have no available email address) *
Phone Number (numbers only) *
Street Address *
City *
Date of Birth *
Age *
Do you have any of the following conditions identified by the CDC as causing increased risk of severe illness from the virus that causes COVID-19? *
Are you immunocompromised due to any of the following conditions? *
We are also forming a list of people in this population group who could get to a St. Peter clinic location within 20 minutes in the event there are unused doses at the end of a clinic. *
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