Forms available to set up vaccination in Phase 1b at Bureau, Putnam and Marshall County Health Departments

Forms only guarantee health department will contact you

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Online forms are available to Bureau, Putnam and Marshall County Phase 1b essential workers and individuals 65 and older to provide information in a fast and efficient manner. The form, however, doesn’t confirm a vaccination appointment time. It guarantees individuals will be contacted in the future by the Bureau, Putnam and Marshall County Health Departments.

If you have already called and given your information to the health department, it is not necessary to fill out a form. If you have called and given your information to the health department, it is not necessary to keep calling. Health officials will contact you as soon as they can with appointment information.

Bureau County: https://www.jotform.com/tmccook/Bureau

Putnam County: https://www.jotform.com/tmccook/Putnam

Marshall County: https://www.jotform.com/tmccook/Marshall