***A new submission needs to be completed for each individual family member***

Currently the vaccine is only approved for ages 18 and older. We are following the Iowa Department of Public Health and Linn County Public Health guidelines for eligibility. This waitlist will allow us to inform you when doses become available. You will still be required to fill out the consent form before receiving the immunization.

Please make sure to fill out the entire form until you get to the last page that says Thank You! You should also receive an email confirmation from Jotform.