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Phase 1C_Survey for Individuals Ages 65 - 74 and Persons ages 16 - 64 with underlying medical conditions

Phase 1C_Survey for Individuals Ages 65 - 74 and Persons ages 16 - 64 with underlying medical conditions

Central Michigan District Health Department is looking to collect some information at this time from individuals who are 65 - 74 years of age OR for individuals ages 16 - 64 with underlying medical conditions.

More information on underlying medical conditions can be found at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.

 
We ask that you answer the questions in this survey as best as you can.  An email address is required.  Thank you for your time.  
This question requires a valid date format of MM/DD/YYYY.
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2. Please select what best describes how you fit into Phase 1C: *This question is required.
3. Please check the county where you plan to be vaccinated. *This question is required.
This question requires a valid email address.