Covid-19 Vaccination Sign-Up | Registro de Vacunación para COVID-19

Let us know how to get back to you.
Háganos saber cómo contactarte.

First Name | Primer Nombre

Last Name | Apellido

Phone | Numero De Teléfono

Email Address | Correo Electrónico

Age | Edad

Birthdate | Fecha de Nacimiento

We will be following Oregon Health Authority priorities shown here (click for PDF).

Brief explanation of why you qualify | Breve explicación de por qué califica para la vacuna

Please download these forms and have them complete before you arrive at your appointment.

Screening Form (English | Spanish) and Consent Form (English | Spanish)

Do you need to have hardcopies of the forms mailed to you? (No printer)

Yes

No

If yes, please enter your full mailing address including zip code