Vaccine NOI Registration

Please use the below links to register your Notice of Intent to receive the COVID-19 Vaccine from Ravalli County Public Health:

This registration form is open to ALL permanent, full-time Ravalli County residents.

Please only use the link to register below that describes your vaccine group.  

You only need to register one time per individual.

Vaccine is extremely limited in supply for the foreseeable future.  We do not anticipate vaccinations to be complete in Ravalli County until 2022.

All individuals Age 70 and above

Individuals Age 16 to 69 with qualifying health conditions

American Indians and people of color

All other residents age 16 and above to include Phase 1C and Phase 2 (general public)

 

Terms and conditions for form:

  1. By submitting this form, this is your notice of intent that you would like to receive the COVID-19 vaccine from Ravalli County Public Health.
  2. By submitting this form, you certify that you meet the age or demographic criteria for your particular vaccine group.
  3. This is available only to full-time permanent Ravalli County residents.
  4. Submission does not guarantee an appointment with any particular provider for this vaccine within a particular timeframe.
  5. Ravalli County Public Health will not guarantee appointments in any particular order with respect to the time of submission of this form.
  6. Vaccine allocations for Ravalli County are arriving in very limited quantities.
  7. Ravalli County Public Health cannot guarantee vaccine from a specific manufacturer (eg. Pfizer or Moderna).
  8. Public Health will use the information to contact and schedule appointments as vaccine becomes available.
  9. We ask that you do not contact Ravalli County Public Health or other Ravalli County Offices or Departments to follow up or check on the status of this submission.
  10. Submission of this form does not prevent individuals from obtaining a COVID-19 vaccine from another provider in or outside of Ravalli County.
  11. Information submitted through this form is submitted to Ravalli County Public Health and is not shared with other providers.
  12. Providing misleading or false information in this submission may result in additional delays in scheduling your appointment to receive the vaccine.