Form Templates by kmonroesegobia

COVID-19 Vaccine Eligibility Form (Lyon County, Kansas)

Form created to help individuals find out if they are eligible for the COVID-19 Vaccine. Currently, this template is configured to approve people in Phase 1 and people aged 65+ per the Kansas Department of Health and Environment (KDHE). If approved, they can be forwarded to an appointment form to continue forward (you will have to input your own link/scheduling platform). If not, they are advised they are currently not eligible after submission. Please be sure to reconfigure links!

Coronavirus Response Forms