Thank you for reaching out to Community Health Care, Inc (CHC) regarding COVID-19 vaccination.
Please complete this form once per person you inquiring about. Please do not attempt to combine information for multiple individuals. Please do not complete this form more than once for each person requesting the vaccine. Repeated submissions for the same person will only cause delays. Si necesita esta forma en espanol por favor cambie el idioma en la esquina arriba a la derecha.