Pacific County weekly COVID-19 vaccine updates
Please complete this form if you would like to receive emails from Pacific County Public Health with updates on COVID-19 vaccine planning, including information about eligible groups and information on when and how to schedule an appointment.

Completing this form will NOT put you on the waitlist for a COVID-19 vaccine.
Sign in to Google to save your progress. Learn more
Name
Email
Mailing address
Phone number
Once eligible, do you plan to take the vaccine?
Clear selection
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