Chickahominy Health District Vaccine Interest Form
Chickahominy Health District will come to your home or business for COVID-19 vaccinations. This service is free of charge. No insurance or identification is necessary. Please indicate your interest by filling out the form below and one of our schedulers will contact you.
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Tell us why you are reaching out:
I need an in-home vaccination for myself or a friend or relative
I am interested in hosting a vaccination event through my church or organization
I would like to have the mobile team come to my business to vaccinate my employees
I have another question about COVID-19 or COVID-19 vaccines and I would like a member of the health district to contact me
Business or Home Address
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This form was created inside of Commonwealth of Virginia.