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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. First Name *

2. Last Name *

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

4. Please Leave Blank

5. Race *

6. Please Leave Blank

7. Street Address *

8. City *

9. State *

10. Zipcode *

11. County of Residence *

12. Phone Number *

13. Email Address *

14. Please Leave Blank

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

16. Insurance Name (if none enter NA) *

17. Member ID (if none enter NA) *

18. Group ID (if none enter NA) *

19. Please Leave Blank

20. Occupation *

21. Position *

22. Employer *

23. Please Leave Blank

24. Are you 65 years or older? *

25. Please Leave Blank

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

27. Are you considered homeless or sheltered homeless? *

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