Vaccine Interest Form

If you were eligible for a COVID-19 vaccine before the general population became eligible due to age, medical condition, or occupation and would like to receive a COVID-19 Vaccine, please fill out our interest form:

Previously eligible COVID-19 Vaccine interest form: https://hipaa.jotform.com/210545112790145

If you are eligible for the COVID-19 vaccine as of 4/5/2021 (general population) and you are unable to make arrangements with a healthcare provider or pharmacy, please fill out our interest form:

General Population COVID-19 Vaccine interest form: https://hipaa.jotform.com/210885191888066

If you have questions about eligibility for COVID-19 vaccine please visit: https://www.dhs.wisconsin.gov/covid-19/vaccine-about.htm


Pfizer COVID-19 Vaccine Administration Record (Consent Form)