The information you provide here is private and secure. We will use it solely to communicate with you about vaccine eligibility and availability as we have information to share.

Are you currently a patient of The University of Kansas Health System? *
Do you have any of the following medical conditions? *
  • Cancer
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease (COPD)
  • Down syndrome
  • Heart conditions, such as cardiomyopathies
  • Immunocompromised state from solid organ transplant
  • Type 2 diabetes mellitus
  • Sickle cell disease
  • Pregnant
Do you have any of the following medical conditions? *
  • Asthma (moderate to severe)
  • Cerebrovascular disease
  • Cystic fibrosis
  • Immunocompromised state (weakened immune system) from blood
    or bone marrow deficiencies, HIV, use of corticosteroids, or use of
    other immune weakening medicines
  • Neurologic conditions, such as dementia
  • Pulmonary fibrosis (having damaged or scarred lung tissue)
  • Thalassemia (a type of blood disorder)
  • Type 1 diabetes mellitus
  • Obesity or severe obesity