COVID-19 Vaccine Request Form

Thank you for your interest in taking the COVID-19 vaccine.

Due to an overwhelming response, we are not currently accepting any additional vaccine registration forms at this time. We will re-open registration after we have scheduled those who have already registered and when we have received additional allocations of the vaccine.   We will update this site and our Facebook page when more information becomes available. Please continue to stay safe. 

For those who have already submitted a registration, please be patient while we process each form.  We are processing registrations based on the date they were received and you may not receive a call for a few weeks.  

For information on questions related to the Moderna COVID-19 vaccine - Click Here

For information on questions related to COVID-19 Vaccination Administration Costs - Click Here

For information on the V-safe Vaccination Health Checker - Click Here

For more information related to COVID-19 please visit the Mohave County Department of Health website - Click Here