COVID-19 Vaccine Contact Form
Completing this form will ensure that you are contacted when a vaccine dose is available at no cost to you. We will bill your insurance company for the cost of administering the vaccine.
You are not required to receive the vaccine from Reedsburg Ambulance by filling out this form. When we contact you, if you have gotten the vaccine from another provider or do not wish to get it, you can let us know at that time.
Please submit your information below. You will be contacted by email with a registration link when vaccines become available.
You must be available three weeks after the initial vaccine to receive the second vaccine.
If you do not have an email, enter "firstname.lastname@example.org"
Reedsburg EMS will be attempting to obtain the vaccine each week and will administer it on Wednesdays from 8:00 am-noon.
Who can get the Vaccine?
Currently, anyone 16 years or older is eligible to receive the vaccine.
It is anticipated that the week of May 10th those 12 and older will be eligible to receive the vaccine. You can start adding anyone over the age of 12 to the list and we will contact you if the vaccine becomes available and is approved for use.
Parent consent will be needed for anyone under 18 to receive the vaccine.