Mobile Vaccine Unit Request

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Are you in need of a mobile vaccine clinic? If so, please fill out the information below.

You will be contacted by someone from our Immunization Team as soon as possible. If you have not received any communication within 3 days from submission, please call 209-468-8400 x28030.

Please note, there may be some clinics we will not be able to accommodate due to short staffing.

Name of Organization

Name of person submitting request

Phone number of person submitting request
*

Can we text the number provided? *

Yes

Email address of person submitting request
*

Name and phone number of contact person for day of event
*

Can we text the number provided? *

Yes

Potential Date of Event

YYYY

Location of Event:

Anticipated time of event

Please check all vaccines you would like us to bring. *

Covid vaccine for adults 19 and up with no insurance or under insured

Covid vaccine for 6 months to 18 yrs old individuals with Medi-cal, no insurance, or underinsured (For children who qualify for VFC vaccines) limited supply

MPOX vaccine offered to all regardless of insurance

Flu vaccines offered to all regardless of insurance

Required

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