New Baden COVID Information

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COVID 19 VACCINATIONS - Clinton County Health Department

ONLY RESIDENTS OF CLINTON COUNTY ARE ELIGIBLE

Our COVID-19 VACCINATION CLINIC is only for New Baden Clinton County residents over the age of 65 (zip codes 62265 and 62266). The health department will let us know when they have the supply to schedule the clinic which could be anytime February through April. We hope to have 250 doses of the vaccination.

This form adds add your name to the list to be considered for appointments. This is NOT a guarantee of an appointment.

If you are over 65 and want to be on the list, please fill out the form below.

If you are over 65 and unable to fill out this form please call our COVID message line at 618.910.4617 and leave the requested information.

REQUIRED INFORMATION:
Name/Names and ages of person requesting vaccine
Address
Phone Number
Date of Birth

You will only be contacted for follow-up if selected for an appointment. Please only contact us either by phone or this form as staff will be inundated with requests. Multiple requests will not increase your chances of getting an appointment for this clinic.

Email *

Do you reside in Clinton County (only New Baden residents in Clinton County are eligible)

Yes

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Name *

Are you over 65 years of age? *

Yes

Date of Birth *

YYYY

Street Address *

Zip Code *

Phone number with Area Code *

Comments

A copy of your responses will be emailed to the address you provided.

Submit

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