Health and Community Services Department

COVID-19 Vaccine Registration Forms & Process

Page last updated on February 16, 2021 at 11:45 am

The Kalamazoo County Health & Community Services Department has launched online COVID-19 Vaccine Registration Waitlist Forms for Employers and Individuals 65 years and older.

Currently, there is a limited supply of COVID-19 vaccine available. The health department encourages those to complete a form to be placed on a waitlist. If you have already completed a form or registered with the health department, do not submit another form.

Review the Health Department’s COVID Vaccination Clinic Metrics as of 2/22/21. This report highlights the specific work by the health department for our vaccination clinics.


We are coordinating closely with healthcare partners to get prioritized groups vaccinated. We are asking organizations to register their business with using the appropriate form below. The forms should be completed by the person responsible for scheduling COVID-19 vaccinations for an agency or organization in Kalamazoo County. The forms collect information for the entire agency/organization and identifies a Point of Contact. The form is not for the public or individuals to complete.

Phase 1A: Critical Healthcare Infrastructure Organization

Healthcare and Critical Infrastructure Form

Phase 1B: Essential Frontline Workers

Essential Frontline Workers Form

Individuals 65 and older

Below are the 4 steps to getting your COVID-19 vaccine if you are over the age of 65

Step 1: Complete the Pre-Registration Waitlist Form for Individuals 65 years and older who live in Kalamazoo County to receive the COVID-19 vaccine

  • Complete the online form to get on the list for a COVID-19 vaccine
    • Vaccination is priority based by risk to the individual and to the community.
  • You will be asked to provide the following:
    • Information about you
    • Contact information, phone and email, that you check often so you can be reached to make an appointment
  • All information is confidential and will only be shared as appropriate
  • Once you submit the form, you will be taken to a page that indicates your form has been successfully received. Please do not call or email to check on the status of your form. If registering by phone, the health department will confirm with you over the phone once you are placed on the waitlist.
  • Click here to complete the Pre-Registration Waitlist Form. You may also call the COVID-19 Call Center at 269-373-5200 to be placed on the list.
  • Congratulations on completing your form! While you wait to hear from the health department, read educational documents regarding safety and the vaccine prior to your appointment:

Step 2: Make an appointment

  • When it is your turn to make an appointment, you will get an email from the health department.
  • It may take a few days, weeks or months to get to Step 2. Please be patient as we are working as quickly as possible to schedule appointments by phone or email.
  • The State of Michigan is currently sending both Pfizer and Moderna vaccine to the health department. Unfortunately, we are not able to offer choice of product of vaccine at clinics given the limited supply we receive.
  • Once you make your appointment, you will get a confirmation email.
    • If you do not see this confirmation email in 24 to 48 hours, please make sure you are registered by contacting the COVID-19 hotline at 269-373-5200

Step 3: Getting 1st Dose of the COVID-19 vaccine

  • Print and complete your Registration Form ahead of time, if you are able. This will save time at the vaccination clinic. If you are not able to, you can complete onsite.
  • At your scheduled time and date – go to the designated location and follow instructions
  • Please wear your face covering and remember to stay 6 feet apart

Step 4: Get Your 2nd Dose of the COVID-19 vaccine

  • You need two doses of vaccine to protect you from the virus
  • You will schedule your 2nd Dose after you get your 1st Dose at the vaccination clinic. Please do not leave the clinic without your 2nd Dose scheduled. Be sure to write down the date, time, and location.
  • Your second dose must be the same product as your first dose.
  • Continue to practice the 3 Ws:
    • Wash your hands
    • Wear your face covering
    • Watch your distance and stay six feet from others.

Vaccination Phases

Kalamazoo County Health & Community Services Department is following the COVID-19 Vaccination Prioritization Guidance as outlined by MDHHS and recommended by the CDC and ACIP.

We are currently vaccinating Phase 1A and Phase 1B Group A (75+ adults), Group B (K-12 Schools and Childcare workers, First responders, Corrections Staff, Congregate Living Staff), and Phase 1C (65-74 year old adults)

Contact Us

311 E. Alcott St
Kalamazoo, MI 49001


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Additional Resources

Michigan Department of Health and Human Services (MDHHS)


Mayo Clinic Health Systems

Kalamazoo County Health & Community Services is committed to providing equitable, culturally competent care to all individuals served, regardless of race, age, sex, color, national origin, religion, height, weight, marital status, political affiliation, sexual orientation, gender identity, or disability. 

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