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This questionnaire is designed to gather information regarding your eligibility for COVID-19 vaccination, and offer guidance and instruction to ensure your safety.
The following application is a process to determine the order of vaccination for the public. Texas will allocate COVID-19 vaccines based on the recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) and the Expert Vaccine Allocation Panel (EVAP). Several Phases have been created in the distribution order of the vaccine. The questions in this application process will place you in the appropriate phase and you will be vaccinated in order, beginning with Phase One. Information entered by the applicant is provided in good faith, however there will be a verification process at the site to improve reliability, validity, accuracy, and accountability of the COVID-19 Vaccination Process.
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Are you immunocompromised?
Which manufacturer’s vaccine did you receive?
Pfizer - BioNTech
Johnson & Johnson - Janssen
On what date did you receive your last vaccine dose?
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