If you are a San Juan County, WA resident, are 65 or older, are not currently COVID vaccinated, and would like to be vaccinated, please complete this form.

This form will be used to take an approximate measure of the number of 65 year old and older individuals in San Juan County who are still in need of vaccine.

This information will not be shared or sold. You contact info may be used to notify you of future vaccine opportunities.

THIS FORM DOES NOT REGISTER YOU FOR A VACCINE. It will be used to better understand the situation and more clearly articulate our need to WA State Department of Health (DOH). This form has been created by the San Juan County Department of Health and Community Services.