Covid-19 Vaccine Pre-Registration
PURPOSE & PRIVACY
The purpose of this form is to identify Lewis County residents who are eligible for the COVID-19 Vaccine so that when vaccines become available, Lewis County Public Health can contact these residents for scheduling and distribution. The information entered on this form will be kept confidential and will be used solely for vaccine registration purposes.
You will be required to provide some personal information, contact information, and affirmatively attest that you are eligible for the vaccine according to the conditions specified on the New York State Department of Health's webpage here --> Phased Distribution of the Vaccine | COVID-19 Vaccine (ny.gov)
Filling out this form does not guarantee that the registrant will receive a COVID-19 vaccine. Lewis County Public Health cannot accurately predict when or how many doses will be provided to Lewis County Public Health. Vaccine allocation, distribution, and priority groups are managed by New York State.