The Kansas City, MO Health Department is following vaccine recommendations from the Centers for Disease Control and Prevention and the Missouri Department of Health and Senior Services.

Completing this form does not mean your practice/organization will receive the vaccine from KCHD. Survey collection is for informational purposes only. If you have questions please visit our COVID-19 Vaccine FAQ page.

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* 1. Name of Organization

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* 2. Which best describes your practice/organization?

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* 3. Number of staff/volunteers to be vaccinated

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* 4. Is your organization enrolled in the Missouri COVID-19 Vaccination Program to become a provider?

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* 5. Has your organization partnered with another organization to receive COVID-19 Vaccinations?

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* 6. Best COVID Vaccine contact for your practice/organization

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* 7. Where do you receive COVID-19 updates? (Specific newsletters, professional organizations, social media accounts, government agencies, news organizations, etc.)

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