Sex
Race
Hispanic Ethnicity
Would you like a reminder notification for the next appointment?
If yes, how?
Insurance Information (Please select one)
Phase 1A - Patient-Facing Health Care Workers and Long-Term Care Facility Residents and Staff: Vaccinating those most vulnerable and those protecting them
Phase 1B - Tier 1 Worker Information: Protecting those who keep us safe and help during emergencies
Options:
Phase 1B - Tier 3 Critical Infrastructure: Protecting those who keep the essential functions of society running
Phase 2, Equity & Economic Recovery: Protecting those who have been disproportionately affected and accelerating economic recovery
Phase 3, Remaining Unvaccinated Populations: Protecting everyone else who has not been vaccinated, but wants to do so