This request form is for the following:
Requesting a specific number of doses set aside at our standing clinics to help ensure equity.
Request an on-site vaccine distribution for a targeted location of individuals such as a senior apartment complex or a site of employment.
Homebound groups or individuals.
Once your information is received, FCPH will reach out to discuss the details of the request as well as specific needs that may be helpful, such as on site translation services and the means of registration.