Care-a-Van Request Form

To access this form in another format or language, please email equity@doh.wa.gov or call 800-525-0127. Language assistance is available.


Clinic will be held Tuesday through Saturday, with each clinic limited to 4 hours. This adjustment allows us to maintain efficiency while ensuring accessibility for all.


The Washington State Department of Health (DOH) strives to keep our communities healthy. If your organization is planning a community event and would like DOH to offer health services, please complete the form below. Care-a-Van is currently offering:

  • Childhood Vaccinations
  • Blood Pressure Screenings
  • Blood Glucose Screenings
  • Mpox (Monkeypox) Vaccinations
  • COVID-19 Vaccinations
  • Flu (Based on availability)
  • Naloxone (Narcan) Distribution Kits
  • Community Based Care Coordination (Based on availability)


We will consider events occurring in less than 14 days on a case-by-case basis. All services are based on availability. Please note that your Care-a-Van request may be forwarded to the Local Health Jurisdiction as part of our practice of collaborating with local health departments. Requests may also be fulfilled by a DOH vaccine contractor should the Care-a-Van not be available.


If you have questions or need assistance filling out this form, please contact care-a-van@doh.wa.gov.