COVID-19 Vaccination Questionnaire

Please fill out the form below to be notified when an appointment for the COVID-19 vaccine is available for you. Appointments will only be available for individuals who are eligible for vaccination based on state guidelines, and outreach will be randomized and equitable. The number of appointments available will depend on the amount of vaccine we receive, and it may take several weeks to work through each phase of vaccination eligibility.

1420 West Midway Blvd., Broomfield, CO 80020   Phone: (303) 466-1866  Fax: (303) 466-4081