Covid-19 Vaccination Request Form
Covid-19 Vaccination Request
The La Pointe Community Clinic is committed to distributing Covid-19 vaccines to our island community as quickly as possible. Please fill in the following fields if you are interested in receiving your Covid-19 vaccine through the La Pointe Community Clinic. The vaccines are free, however, we will bill your insurance for a small administrative fee. After you have filled this form out, we will contact you as soon as possible to follow up with appointment details. We understand that many of you are eager to receive your vaccine. We are following the CDC’s phased guidelines, so please be patient! If you have already contacted the clinic in regards to a Covid-19 vaccine request, please do not fill out this form.
Please fill separate forms for every member of your family even if they reside in the same household.
If you are a new patient to the La Pointe Community Clinic, please denote in the message field.
Thank you!
-The La Pointe Community Clinic