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Pre-Registration Form: Click Here
(or click here for a fillable PDF version of the Pre-Registration Form)
Do not attempt to submit this form ahead of time. Instead, we will need you to bring this form to the clinic with you the day that you receive your vaccine.
Versión en español: https://drive.google.com/file/d/1W4nSI2veO6a9RBsHpZ_-fP7QZULrV2uP/view?usp=sharing
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Prior to arriving at the clinic, please remember the following:
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While insurance companies can be billed by the County to help recover cost, the COVID-19 Vaccine is free to everyone. This means that there will be no out of pocket cost from anyone receiving the vaccine. We will never contact you asking you to pay for the vaccine or for sensitive information such as passwords, social security numbers, financial information, etc.
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If you need further assistance or know someone that needs further assistance, we have a live call center during normal business hours that can be contacted: (336) 849-7950
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