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Date of Birth
Have you had treatment for COVID-19 (monoclonal antibodies) in the last 90 days?
Uknown / I don't know
Do you live or work in Reno County, Kansas?
Do any of the following match your personal situation?
Select any that are applicable
I am a health care or front-line worker
I am 65+ years old
I live in a licensed congregate setting
Aged 18-64 with Medical Risks
I am a high-contact critical worker
Other Critical Worker
Who is your employer?
Unlisted / Other, High-Contact Critical Worker