COVID-19 Vaccine Waiting List for Richland County, Montana
PLEASE READ THIS MESSAGE BEFORE SIGNING UP
Please use the following form to register for the COVID-19 vaccine waiting-list for those seeking the first dose of the COVID-19 vaccine.
You will be contacted by the Health Department using the telephone number you provide when an appointment is available for you at a scheduled clinic. You will be contacted in the order that you submitted your information. Appointments are subject to vaccine availability.
These responses are confidential and are only accessible by the Health Department.
If you have questions or need assistance, please call 406-433-6947.
Date of birth (MM/DD/YYYY)
Telephone number with area code (NNN-NNN-NNNN)
Email address, if applicable
Please read the following statement and check the box: I am aware that my vaccine is a scheduled appointment, and that it is important to keep my appointment. If I am unable to keep my appointment, I will notify the Health Department by phone at 406-433-2207 as soon as possible so my dose can be given to the next person. I am aware that if I fail to keep my appointment without calling, I will be moved to the end of the waiting list.
I have read the statement and agree to call the Health Department if I can't keep my appointment.
Are you interested in receiving important emergency-related information from the Health Department? If so, please check all that apply:
E-mail me (Did you provide your email above?)
I am not interested at this time
Thank you for your patience as we schedule vaccinations. Please expect a 2-3 week wait time before we contact you with an appointment-this is subject to change. If you have questions, please contact the Health Department at 406-433-6947.
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This form was created inside of Richland County, Montana.