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2. Please complete this form to be removed from the County's COVID-19 Vaccine standby list.
4. First Name*
5. Last Name*
7. Email
8. Phone Number*
10. Thank you for letting us know you were able to secure a COVID-19 vaccine appointment through a pharmacy, provider's office, or a health department clinic! You are helping to ensure our clinics are able to run as smoothly and efficiently as possible.
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12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

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