COVID-19 Vaccine Sign-up

COVID vaccines are now available at the Alexander County Health Department for:
those in Phase 1a (healthcare workers) and Phase 1b – Group 1 (citizens ages 75+).

If you would like to register to get the vaccine, please complete this form and we will contact you when vaccines are available and in the order the form was received. This could be a few weeks before you are contacted.

Name*
First Last
Age*
Please enter a number greater than or equal to 16.
Birthdate*
Phone Number*
Email
Address
Street Address City State ZIP Code
Are you between the ages of 16 and 64 and have a high-risk medical condition such as cancer, COPD, serious heart conditions, sickle cell disease, Type 2 diabetes, among others?*
- Yes
- No
Occupation*
Healthcare, transportation, manufacturing, education, retired, student, etc.
Comment/Additional Info.
Email
This field is for validation purposes and should be left unchanged.