Van Buren/Cass District Health Department is administering COVID-19 vaccine to anyone 18 years and older.  We will notify you using the contact information provided when we are able to schedule you for COVID-19 vaccination, please ensure the information is accurate before submitting.  

We encourage you to also check our website at www.vbcassdhd.org/covid-19-vaccine/ for current vaccine appointment offerings.  Vaccine clinics are added frequently. 

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* 1. Name

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* 2. County

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* 3. Age

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* 4. Do you have an underlying health condition that would put you at risk of severe illness due to COVID-19 infection?  (COPD, hypertension, chronic kidney disease, heart disease, diabetes, obesity or other conditions that put you at high risk of negative COVID-19 outcome)

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* 5. Email Address

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* 6. Phone Number

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* 7. Address

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* 8. Are you currently employed?

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* 9. If yes, what type of setting are you employed in? 

Please note: If your field is not listed below, unless you meet other priority criteria such as age or underlying health conditions, you will be included in Phase 2

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* 10. If employed, name of employer

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