Manila COVID-19 Vaccination Clinic

Manila COVID-19 Vaccination Clinic

TriCounty Health Department receives a limited number of COVID-19 vaccine weekly. TriCounty will provide a mobile clinic in Manila to facilitate COVID-19 for residents 65 year of age and older and individuals with specific health concerns.
Name *

First Name Last Name
Please select your county of residence *
Vaccines provided at the TriCounty Health Department are intended only for individuals who live in the TriCounty area, Daggett, Duchesne, and Uintah Counties. If you live in another county please contact your local health department for information on how you can receive your COVID-19 vaccine.

Thank You
Are you 65 years of age or older, a healthcare worker, or educator or have a specific health concern? *
TriCounty Health Department will be provide vaccines for individuals over the age of 65, healthcare workers, educators, and individuals with specific health concerns. Please continue to check the TriCounty Health Department website for more information for other age groups to receive the vaccine.
Personal Information
Birthdate *

Month Day Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Insurance Information.

Please include insurance information. The COVID-19 vaccine is free but Doctors and nurses may be reimbursed by insurance companies for administering the shot. Please click the link below to review why we collect this information.
Why we collect insurance information
Insurance Provider
Insurance Group Number
Insurance Policy Number
Social Security Number
Please select your appointment time for your first shot *
Please select your appointment time for your second shot *
Should be Empty:

Manila COVID-19 Vaccination Clinic

Personal Information

Insurance Information.