COVID-19 Phase 1B Vaccination Registration Form
The following people are considered eligible for vaccination in Phase 1BÂ
Name
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
County
City/Town
Phase 1BÂ Group
Law Enforcement
Fire Personnel
Front-line Critical Workforce Employee
Specify Employee Type
Other
Only certain health departments currently have vaccine. Please select which health department you prefer to be contacted by for your vaccine appointment:
Chattahoochee
Clay
Columbus
Crisp
Dooly
Harris
Macon
Marion
Quitman
Randolph
Schley
Stewart
Sumter
Talbot
Taylor
Webster
Submit
Should be Empty: