To help us plan for vaccine clinics based on the amount of vaccine received/available please fill out this form.
Please type your birth date in the following format MM/DD/YYYY or click on the little blue symbol and a calendar will pop up to make a selection.
Mailing Address (please include CITY, state, and zip code) Example: 2200 4th Street, Baker City, OR 97814
Please select the closest location to where you live or where you would like to receive the vaccine when it is available.
Because there is not enough vaccine for everyone immediately we are working on a sequencing plan. Please select the appropriate group you feel you fit in.
Do you have one of the folowign medical conditions that may cause increased risk of severe illness from the virus that causes COVID-19? These include: - Cancer - Chronic Kidney Disease - COPD (Chronic Obstructive Pulmonary disease) - Down Syndrome - Heart Conditions (such as heart failure, coronary artery disease, or cardiomyopathies) - Immunocompromised State (weakened immune system) from solid organ transplant - Obesity (body mass index of 30 kg/m2 or hight but less than 40 kg/m2) - Pregnancy - Smoking - Severe Obesity (body mass index equal or greater than 40 kg/m2) - Sickle Cell Disease - Type 2 Diabetes Mellitus
Example: shingles, pneumonia, tetanus, flu
Your employment may impact your vaccine group, please select the employment category that you belong to:
By checking this box, you attest that the information above is accurate to the best of your knowledge.
By checking this box, you agree to receive communication (email, text, phone) updates from Baker County.