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Based on availability, and guidance from the Missouri Department of Health and Human Services (MO DHSS) and the Center for Disease Control (CDC), the Taney County Health Department will be providing the COVID-19 vaccine based on a pre-determined tier system. Individuals will be identified to receive the vaccine based on risk status and occupation. 

Once the vaccine is made available for your tier, the Taney County Health Department will use your information from the survey below to contact you with further instructions on how to schedule an appointment to receive your vaccination. 

Per the guidance provided by the CDC, COVID-19 vaccinations will not be provided to those under the age of 16. 

1. Do you have insurance, medicaid, or medicare? *


2. Do you consent to receive text messages or email notifications for scheduling opportunities or vaccine updates? *


3. Are you considered homeless or sheltered homeless? *


4. Do you have a chronic condition that increases your risk for severe illness? (heart disease, diabetes, immunocompromised, severe obesity, etc.) *


5. Please Leave Blank


6. Are you 65 years or older? *


7. Please Leave Blank


8. Employer *


9. Position *


10. Occupation *


11. Please Leave Blank


12. Group ID (if none enter NA) *


13. Member ID (if none enter NA) *


14. Insurance Name (if none enter NA) *


15. First Name *


16. Please Leave Blank


17. Email Address *


18. Phone Number *


19. County of Residence *


20. Zipcode *


21. State *


22. City *


23. Street Address *


24. Please Leave Blank


25. Race *


26. Please Leave Blank


27. Date of Birth (MM/DD/YYYY) *


28. Last Name *