COVID-19 Phase 2 Vaccination Registration Form
The following people are considered eligible for vaccination in Phase 2
Name
First Name
Last Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
County
City/Town
Phase 2 Group
Adults between the ages of 40 to 64
Individuals in congregate settings, such as homeless shelters, group homes, dormitories
Individuals in jails, prisons, detention centers
Any others living in congregate settings
Other
Other
Only certain health departments currently have vaccine. Please select which health department you prefer to be contacted by for your vaccine appointment:
Columbus
Dooly
Crisp
Talbot
Chattahoochee
Marion
Taylor
Stewart
Clay
Quitman
Randolph
Schley
Macon
Harris
Webster
Sumter
Submit
Should be Empty: