Health Department
To register for ages 55 and Over for COVID-19 vaccination appointment with the New Canaan Health Department clinic complete the following registration form.
 
You will be notified for an appointment when it is available for you at Lapham Community Center during the month of February or March.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
New Canaan Address *
Date of Birth *
MM
/
DD
/
YYYY
Phone number -Best number to be reached during daytime hours. *
Email
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy