COVID-19 Vaccine Interest and Screening Form
Please complete this form if you would like to be notified when your COVID-19 vaccination can be scheduled in Houston County. Scheduling your vaccination will depend on identified priority groups and available vaccine supply. We cannot guarantee when you will be scheduled for the COVID-19 vaccine. This form is a way to identify and communicate with individuals in the various priority groups; this is just the first step in identifying those that qualify. This form should be completed only one time and it may take some time before an appointment can be scheduled. Those not currently eligible for the vaccine will be able to provide contact information for the Health Department to contact you when we move to additional phases.
Houston County Public Health and Human Services continue to receive a high volume of calls and ask that people who complete the Vaccine Interest and Screening Form do not send multiple messages or phone calls.
The type of vaccine currently available in Houston County is Moderna. It is available to those age 18 and over. Moderna is given in a 2 dose series; you must commit to receiving the 2nd dose in order to receive the 1st dose. Note: If you have any history of severe allergies to vaccines, you should discuss the COVID-19 vaccine with your healthcare provider.
If you have questions about this form, please contact us at Houston County Public Health & Human Services at firstname.lastname@example.org
Thank you for your patience!