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Posted on: February 18, 2021

Benton County Residents (65+) COVID-19 Vaccine Interest Survey


This interest form is for Benton County residents who are age 65 years or older who would like to get the COVID-19 vaccine. This survey is NOT to schedule an appointment at this time. It will be used to gauge interest and collect contact information so when vaccine becomes available local public health will reach out to you to schedule an appointment. Please fill out ONE survey for each person age 65 or older who lives in Benton County. Remember to click on the "done" button at the bottom of the page when you are finished.

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