Are you interested in receiving the COVID-19 Vaccine?

Olathe Health will provide current patients the COVID-19 vaccine based on a phased approach pre-determined by the Kansas Department of Health and Environment. See the full phasing plan here.

As the vaccine is made available for each of the phases, Olathe Health will use your information from this survey to contact you with further instructions on how to schedule an appointment to receive your vaccination. 

Please Note: This survey is not an appointment and does not reserve a vaccine for you. Olathe Health will receive the vaccine in limited quantities on an ongoing basis from the state. Thank you for your patience as you wait for your vaccine to be available based on your phase.

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* 1. Full Name

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* 2. Email Address

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* 3. Phone Number

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* 4. Age

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* 5. Primary Care Doctor's Name

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* 6. Primary Care Clinic Name

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