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COVID-19 Vaccine Sign-Up

Currently those eligible in Phase 1B are residents age 65 and older

If you are age 65 or older OR if you work in a PK-12 school setting or daycare, you are in Iowa’s Phase 1B of COVID-19 vaccination priorities. Because supplies are limited, Orange City Area Health System is offering the primary dose of the Moderna vaccine to these two groups of individuals as it is available.

If you meet the criteria mentioned above, fill out the registration form below to get on our waiting list. If you prefer, you may call our clinic at 712-737-2000 Monday-Friday, 10am-4pm to be put on this wait list. If you are not 65+ OR work in a school or daycare setting, please do not fill out this form or call us until you are eligible. We will update our Facebook page, website, and this waiting list when the state of Iowa notifies us that other phases or groups of people are eligible for vaccination. Please only sign up once.

Depending on when the vaccine is available, you will be contacted to schedule your vaccination appointment for your primary dose. Thank you for your patience and cooperation.

Fields marked with an asterisk* are required.

COVID-19 vaccination sign-up form
Are you age 65 or older?* *
Do you work in a PK-12 school setting or daycare?* *
*Have you received treatment for COVID-19 in the last 90 days. (ie: Monoclonal Antibody Infusion: Bamlanivimab ‘BAM’, Casirivimab/Imdevimah ‘Regeneron’, Convalescent Plasma) *