LTCF Vaccine Clinic Requests
Long Term Care Facilities in Alameda County in need of an on-site COVID-19 vaccination clinic should complete this form to notify Alameda County Public Health Department (ACPHD) of the request. Please provide the approximate number of individuals (staff and residents) who are interested in receiving the COVID vaccine. Also, please let us know the preferred date of the vaccine clinic.
Clinic staff will be offering the updated COVID vaccine and the current flu vaccine.
Please DO NOT submit multiple times for the same location. Our team is working as quickly as possible and will reach out with additional details.
You can direct any additional questions to Lianna.Laingor3@acgov.org or 510-667-7950
*PLEASE DO NOT SUBMIT THIS FROM A MOBILE DEVICE. IT WILL NOT GO THROUGH!*