COVID-19 Vaccine Waitlist
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Date of Birth
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Phone Number
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Email
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Select ONLY ONE of the following categories that applies to you.
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Long-term care facility residents
Front line Health care personnel
Persons not directly involved in patient care but potentially exposed to infectious material that can transmit disease among or from health care personnel and patients
Persons ages 65 and older
Cancer
Chronic kidney disease
COPD
Down Syndrome
Immunocompromised state (weakened immune system) from solid organ transplant or from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
Severe Obesity (BMI ≥ 40 kg/m2)
Pregnancy
Sickle cell disease
Smoking
Type 2 diabetes mellitus
None of the above
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