COVID-19 Vaccine Contact Form
- When submitting the form, please be sure contact information, including name, phone number and email address, is accurate.
- After this form has been submitted, we will contact you via email or phone to register for a vaccination clinic. When contacted, please make sure your health insurance information is easily accessible as it is required during the registration process. The vaccine itself is being provided at no cost by the federal government; insurance will be charged for the cost of administering the vaccination. Individuals will not be turned away for not having insurance.