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COVID-19 Vaccine and Testing Request Form


Health Education

COVID-19 Vaccine and Testing Request Form

Live in South Los Angeles, Huntington Park, Cudahy, Montebello, or the surrounding communities, and need a COVID-19 test or vaccination?
Please provide us with your details if you are 18 and older, and with the child’s details if you are the parent or guardian, and one of our representatives will contact you to confirm your appointment.
If the test or vaccination is for a child, please note that COVID-19 vaccinations are currently approved for children over the age of five (5).

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