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This form is to be completed by those who fall into Phase 1A of the COVID-19 vaccination prioritization guidance. This includes health... More… This form is to be completed by those who fall into Phase 1A of the COVID-19 vaccination prioritization guidance. This includes health care workers part of the health care infrastructure. Please do NOT complete this form unless you are a health care worker. Please see this webpage for further definition of those who fit into Phase 1A: http://bchdmi.org/1745/COVID-19-Vaccine-Information After completing this form, you will receive additional information regarding how to make an appointment to receive your COVID-19 vaccine. Less…