Reporting Vaccine Provider Concerns
Administering COVID-19 vaccines quickly to everyone in Colorado who would like one is challenging, and it requires flexibility, innovation, and patience. We are aware that there may be times where the guidelines CDPHE has issued are not followed. This creates barriers for access to vaccine. CDPHE has created this form for the general public to report concerns related to COVID vaccine distribution.

*NOTE - Please do NOT report non-vaccine related COVID concerns via this form. For general COVID concerns, please report those here: https://covid19.colorado.gov/CovidConcerns

The following are some examples of vaccine distribution issues:

- Requiring insurance and/or Identification to receive the vaccine
- Not following state phasing guidelines
- Charging for an office visit
- Requiring an administration fee to receive the vaccine
- Not observing patient for 15 minutes after vaccine administration

We may follow up with you for additional information, please note for confidentiality purposes your name will not be shared.

If you are unable to complete this form and require assistance, please call us at 1-877-CO VAX CO (1-877-268-2926).
County where the vaccine was received:
Name of Clinic/Provider:
Date vaccine was received or scheduled:
MM
/
DD
/
YYYY
Were you denied access to a second dose?
Clear selection
Was this a first or second dose?
Clear selection
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