• COVID-19 Vaccine Eligibility Form

    The following questions will help us determine if you are eligible to receive the vaccine. If you do not qualify, do not worry. You will become eligible in the future as we move forward. Lyon County Public Health is working to vaccinate individuals by risk severity. If you are unsure of a question, please reach out to public health or your healthcare provider.
  • Format: (000) 000-0000.
  • Select the option that best represents you, otherwise select "none of the above". (Another section will appear after selecting "none of the above")*
  • Select the option that best represents you, otherwise select "none of the above". (Another section will appear after selecting "none of the above")
  • Select the option that best represents you, otherwise select "none of the above". (Another section will appear after selecting "none of the above")
  • Select the option that best represents you, otherwise select "none of the above". (Another section will appear after selecting "none of the above")
  • Select the option that best represents you, otherwise select "none of the above". (Another section will appear after selecting "none of the above")
  • Select the option that best represents you, otherwise select "none of the above".
  • Should be Empty:
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