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COVID-19 Interest Forms

We are not currently able to register everyone who is eligible for vaccination. Our weekly vaccine allocation is much lower than the number of people in the current phase, 1B. We ask that you do not widely share registration links with those who would be ineligible for an appointment. Our team verifies all appointments before administering vaccine. If you make an appointment and are not part of a priority group, you will be turned away. Our team is working to organize clinics as quickly as our vaccine supply allows.

For more details on our vaccination planning, visit our vaccination web page.

If you are interested in receiving the COVID-19 vaccine, please complete the appropriate interest form, below. This is NOT a registration form.

We will contact people who complete this form with additional information on registration as it becomes available. Please complete one form per person. If you need assistance completing the form, please call our call center at 410-876-4848, open Monday-Friday, 8 am – 5 pm. Please be patient. We are experiencing an extremely high volume of calls.

Please make sure you are filling out the correct form. You will need to bring a photo ID and proof of eligibility to vaccination clinics.

We currently have the Moderna vaccine at the Carroll County Health Department and the Moderna vaccine can only be offered to individuals ages 18+.

The Carroll County Health Department (CCHD) cannot provide any medical advice regarding whether or not you should receive the vaccine. You should talk to your healthcare provider before signing up to receive the vaccine.  The CCHD reserves the right to decline to vaccinate any individual we do not feel safe vaccinating as we have limited medical support services on site. For CDC information on underlying health conditions and COVID-19 vaccination: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/underlying-conditions.html

Phase 1A

Phase 1A: If you are a health care provider, law enforcement officer, or first responder in 1A, and you live or work in Carroll County, please complete this form to be on our interest list for the COVID-19 vaccine: 

https://docs.google.com/forms/d/1JSRonZPZWpiM9I4lgQA9BzocH1jyrPDsefPhhD3SN4M/edit?usp=sharing

Phase 1B: If you work at a private school or childcare agency in Carroll County, please speak with your school administration or childcare owner about vaccination.

We may not plan additional targeted clinics for these groups. We will keep people on the list informed of other opportunities. You are eligible to be vaccinated at other sites and may want to try to find an appointment through retail pharmacies, large clinics, or the state’s mass vaccination sites: https://coronavirus.maryland.gov/pages/vaccine#locator

 

Carroll County residents age 75+.

If you are 75+, please complete our interest form survey so that we may contact you with information and instructions about how to make a vaccination appointment. If you are unable to complete the survey online, consider asking a friend, neighbor or family member for assistance. Please note: You WILL NOT receive an appointment after completing the survey. This is an interest form only to collect contact information. Please complete one form for each person who is age 75+ and interested in being vaccinated: https://forms.gle/iQ4VWP6vmtQCErQv6

 

Carroll County residents between the ages of 65-74.

If you are between the ages of 65-74, please complete our interest form survey so that we may contact you with information and instructions about how to make a vaccination appointment. If you are unable to complete the survey online, consider asking a friend, neighbor or family member for assistance. Please note: You WILL NOT receive an appointment after completing the survey. This is an interest form only to collect contact information. Please complete one form for each person who is age 65-74 and interested in being vaccinated: https://forms.gle/qDii9N1m4bJDxEJy9

 

Carroll County residents under the age of 65 with health conditions that increase risk of serious illness from COVID-19 (see CDC list).

If you are under the age of 65 with health conditions that increase the risk of serious illness from COVID-19 (see CDC list), please complete our interest form survey so that we may contact you with information and instructions about how to make a vaccination appointment. If you are unable to complete the survey online, consider asking a friend, neighbor or family member for assistance. Please note: You WILL NOT receive an appointment after completing the survey.This is an interest form only to collect contact information. Please complete one form for each person who is has one of the above mentioned health conditions and is interested in being vaccinated: https://forms.gle/AR23nZZrNU4TnH2d6

 

Essential Workers in Carroll County.

If you are an essential worker, please complete our interest form survey so that we may contact you with information and instructions about how to make a vaccination appointment. If you are unable to complete the survey online, consider asking a friend, neighbor or family member for assistance. Please note: You WILL NOT receive an appointment after completing the survey. This is an interest form only to collect contact information. Please complete a separate form for each person who is interested in receiving the vaccine and is an essential worker in critical utilities, transportation, food service, etc.: https://forms.gle/oipZsLuFKtqB94uk9

 

Carroll County – General Population (not in priority groups 1A, 1B, 1C, or 2).

If you do not fall under priority groups 1A, 1B, 1C, or 2: please complete our interest form survey so that we may contact you with information and instructions about how to make a vaccination appointment. If you are unable to complete the survey online, consider asking a friend, neighbor or family member for assistance. Please note: You WILL NOT receive an appointment after completing the survey. This is an interest form only to collect contact information. Please complete a separate form for each person who is interested in receiving the vaccine and that do not fall in to any priority groups: https://forms.gle/hRUHkbY3gdyVesh66