Kent County Health Partners COVID-19 Vaccination Survey
Kent County Health Partners are currently vaccinating individuals within Phase IA and some categories in Phase 1B. At this time, appointment availability is limited due to the supply of vaccine. Following completion of this survey, a Health Partner representative will contact you as vaccination appointments become available. Please note: it may take several weeks before you are contacted to schedule an appointment.
For the COVID-19 vaccine to be effective, people should receive a second dose no earlier than 21-28 days after their initial vaccination, and from the same manufacturer. For that reason, it is important that you are available during that time frame.
If you need assistance filling out the form, please call 211 or the Kent County Health Department @ 616.326.6992 for assistance.
* Indicates Required Field
Why do we ask about race and ethnicity?
We ask questions about a person’s race and ethnicity so that we can ensure our vaccination practices promote equitable distribution. You are not required to answer the ethnicity and race questions to schedule an appointment.
Why do we ask about age and occupation?
The CDC and the State of Michigan MDHHS have established phases for vaccine distribution to achieve both maximum benefit to the community and equity in distribution. Some phases are identified by age (for instance 65+ or 75+) and others are identified by job type (for instance Healthcare Workers or Firefighters). You are not required to answer the employment question to schedule an appointment. The State Health Department may prioritize additional job types of essential workers in upcoming months. Kent County Health Partners recognize that there are other essential worker categories and want to be able to reach you if these categories become eligible in a future phase.
Underlying Health Conditions:
- 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 [BMI] of 30 kg/m2
- Sickle cell disease
- Type 2 diabetes