CDC Vaccination Card Request
Please use the form below if you received your COVID-19 Vaccinations from CHA but have lost the CDC card with the verification information. If you wish to receive you card by mail, please include your current location. We ask for your patience as delivering your vaccination card may take up to two (2) weeks by mail.
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Full Name *
Email *
Date of Birth *
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Daytime Phone *
Address 1
Address 2
City
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ZIP / Postal Code
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