Pamlico County Health Department COVID-19 Vaccine Request Form

At this time, Pamlico County Health Department is accepting vaccine requests for all Groups. You can review the full criteria at the following link: https://covid19.ncdhhs.gov/vaccines. The Pamlico County Public Health Department is committed to making sure everyone who wants to get the COVID-19 vaccine can get it when it is their turn.  

To help us do that we are asking individuals to complete this form. The information you provide will be used to share updates on our progress with the COVID-19 Vaccine rollout and information on how to register for the vaccine when it is your turn. 

The information you provide will be added to our vaccine interest database.
Please be sure to provide us accurate information so we can determine your eligibility for each phase of the vaccine rollout and contact you when needed. Additionally, please include only one person per submission. 

Thank you for your interest and patience as we work to provide vaccinations to our community.

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Pamlico County Health Department COVID-19 Vaccine Request Form

Pamlico County Health Department COVID-19 Vaccine Request Form

At this time, Pamlico County Health Department is accepting vaccine requests for all Groups. You can review the full criteria at the following link: https://covid19.ncdhhs.gov/vaccines. The Pamlico County Public Health Department is committed to making sure everyone who wants to get the COVID-19 vaccine can get it when it is their turn.  

To help us do that we are asking individuals to complete this form. The information you provide will be used to share updates on our progress with the COVID-19 Vaccine rollout and information on how to register for the vaccine when it is your turn. 

The information you provide will be added to our vaccine interest database.
Please be sure to provide us accurate information so we can determine your eligibility for each phase of the vaccine rollout and contact you when needed. Additionally, please include only one person per submission. 

Thank you for your interest and patience as we work to provide vaccinations to our community.

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