Covid-19 Vaccine Form

If your organization is in the State of Ohio Prioritization List, please complete this form to be placed on our vaccination scheduling list.  We will work with you as we continue to receive doses from the Ohio Department of Health.  We do not have an ETA on when doses will be available.  Please only submit this form if you are in the Phase 1A list and live or work in Warren County.  All others will not be kept until they match a Phase.  You will need to submit a new form at that time.