La Crosse County Health Department posts vaccine request form

LA CROSSE, Wis. (WKBT) — Anyone seeking a COVID-19 vaccine should complete an online form to be connected with a vaccine provider, according to the La Crosse County Health Department.
The department launched the new Vaccine Screening and Interest Form Tuesday to connect eligible vaccine recipients with providers, according to a health department news release.
Gundersen Health System and Mayo Clinic Health System will contact patients through MyChart and Patient Online Services, the department said. Current Mayo Clinic Health System patients through patient online services or letters in the mail. If a provider contacts a patient, the person does not need to complete this form.

Completing the form is the quickest way to ensure a connection to a vaccine. The form should be completed only once, but it may take some time before a vaccine provider reaches out to schedule an appointment.
Those who are not eligible to get a vaccine now will be able to provide contact information for the health department to contact you when it moves to additional phases for vaccination.
At this time, Wisconsin is vaccinating only those who are classified in Phase 1A, which includes:
• Front-line healthcare workers
• Individuals 65 and older
• Law enforcement or firefighting employees
• Other 1A eligible employees who may have missed previous vaccination opportunities.
On Jan. 25, individuals older than 65 also will be eligible for vaccination. When the vaccine supply is limited, it will be prioritized for those at highest risk of severe illness and death from COVID-19.
The next wave, Phase 1B, may include individuals who work in one of the following settings:
• Educators and child care providers
• Non patient care employees in health care or hospitals
• Mink husbandry
• Homeless shelters
• Individuals who live or work in congregate settings such as assisted-living facilities, community-based residential facilities, group homes or residential treatment facilities whose facilities do not have the ability to work with the federal pharmacy partnership program.
It will take time to vaccinate these populations, and supply will dictate the timeline.
The health department and local health systems continue to receive a high volume of calls and ask people who complete the form not to send multiple messages or make multiple phone calls.
Questions about the form can be sent to The most up-to-date information about COVID-19 vaccines can be found at the county health department website.