Los Angeles County In-Home COVID-19 Vaccination Request Form
 
***Please note, this form has been moved to a new page. Use this link to access the in-home vaccination request form:  https://redcap.link/vaxathome

For other facility requests for a mobile clinic event, please complete the COVID-19 Mobile Vaccine Team interest form: https://forms.office.com/Pages/ResponsePage.aspx?id=SHJZBzjqG0WKvqY47dusgRhkHSYxz5JKiyxHrBS9oFNURDVOVjNMTlFOTDMzTVBESktZU1g5VTExOS4u
 
We thank you for your patience and understanding. If you have more questions about the COVID-19 vaccine or how to access vaccine appointments, please call 833-540-0473 (8:00am - 8:00pm, 7 days a week) or check out our website at ph.lacounty.gov/VaxAtHome (ph.lacounty.gov/VacunacionEnCasa). If you have specific questions regarding homebound vaccination, please contact CovidVaxHomeBound@ph.lacounty.gov.