By completing this survey, you are requesting that the Kauai Mobile Vaccine van attend a certain event/location. We will try to accommodate as many requests as we can. The van schedule is Saturday-Wednesday from 1-7. Please only make requests during this window.

At this time, only J &J (one dose) and Moderna (two doses) will be offered to adults 18 and over. The mobile vaccine van will not carry Pfizer vaccine, and therefore, children will not be eligible to be vaccinated through the mobile van. This may change in the future, so please stay tuned. Mahalo for doing your part to protect our community by choosing to get vaccinated!

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* 1. Name of requestor

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* 2. Contact phone #

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* 3. Physical address where you would like the vaccine van to go to

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* 4. Requested date and time. It doesn't have to be a specific date, but please provide detailed information on the best days of the week and time of day.

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