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COVID Vaccine Interest Survey

COVID 19 VACCINE INTEREST SURVEY

The Jackson County Health Department is administering COVID-19 vaccine based on priority groups determined by MDHHS and subject to vaccine availability. This form determines the Phase and Priority group for individuals and workplaces, and collects contact information.  We will notify you using the contact information provided when we are able to schedule you for your COVID-19 vaccination.    Healthcare workers who are employed at hospitals or health systems (hospitals, clinics) should seek the vaccine through your employer, and not use this form.

This is a short survey and will take a few (less than 10) minutes to complete. It is important to use the next and back keys on the survey and not on your keyboard as it can mess up your survey. Please scroll all the way down when answering questions to make sure you have answered everything.  If you don't have an email, please make sure to list a phone number or use a messenger email.

The last message you will receive is a message notifying you of the priority group you fall in and that you will be notified when you can sign up for a clinic time  If you are completing this survey as a business, you will receive a message regarding who will be contacting you.