This registration is not for appointments and is intended only for INDIVIDUALS WHO ARE HOMEBOUND.

If you have mobility challenges, or are homebound and cannot leave your home to go to a vaccination clinic, please fill out this survey. Your Fire/EMS agency can contact you as vaccine becomes available. Limited quantities of vaccine are circulating in Ohio. As the State gets a better handle on incoming quantities, we will be working to further develop our distribution.

Please fill out the information in this survey and your Fire/EMS agency will contact you based on your responses.

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