COVID Information

VIM HHI COVID-19 VACCINE REQUEST

  • Male
  • Female
  • Hispanic
  • Non-Hispanic
  • Hispanic / Latino
  • American Indian / Alaskan Native
  • Caucasian / White
  • African American / Black
  • Asian
  • Native Hawaiian / Pacific Islander
  • 2 or more races
  • Choose one below
  • Phase 1A: Age over 65
  • Phase 1B: Age Over 55
  • Phase 1A: Healthcare worker in a healthcare setting
  • Phase 1B: Firefighter
  • Phase 1B: Police
  • Phase 1B: EMS
  • Phase 1B: Grocery Store Worker
  • Phase 1B: Teacher / Support Staff
  • Phase 1B: USPS Employee
  • Phase 1B: Food & Agricultural Worker
  • Other (you MUST explain below)