Business Request for COVID-19 Vaccine Clinic
Submit a completed request form if you are interested in the Elkhart County Health Department coming to your place of business to provide COVID-19 vaccines. Someone from the Health Department will contact you within 3 business days to discuss request.
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Business Name & Address (must be in Elkhart County) *
Contact Person, Title,  & Phone Number *
Number of employees interested in getting the COVID-19 vaccine (must have a minimum of 20) *
Are bilingual translators needed?
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Is there space(s) to accommodate our staff and a seating area where employees will wait for 15 minutes after they receive the vaccine?
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Submit
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