Vaccinations for individuals who are homebound- Pacific County
This form is for individuals who are homebound and who would like the COVID 19 vaccine. Health Department staff or another local vaccine provider will use this information to schedule appointments with you to come out to your home to provide the vaccine. Please fill out a separate registration form below for each individual who needs a home based vaccination. This is a secure form and any information you submit to us via this form, such as your contact information and address, is protected.
Once the survey is submitted, you will see a message informing you that the form has been accepted. Depending on the survey response, we will either contact the individual needing the vaccination or the one who submitted the survey. For any questions, please call 360-875-9407.