Vaccine Pop-up Site - Riverside County
Vaccine Appointment Eligibility
Please note that pop-up sites can only vaccinate people in eligible tiers. Please see these letters from DDS on eligibility:
High-Risk Medical Eligibility Effective March 15th
Vendor/DSP Eligibility Letter
Family Caregiver Eligibility Letter
OK
1.
Company or Facility Name
2.
Site Address
3.
Contact Person Name
4.
Contact Phone Number
5.
Contact Person Email
6.
Please indicate if you are able to host a pop-up clinic indoor, outdoor, or both
Indoor Space Only
Outdoor Space Only
Both Indoor & Outdoor Space
7.
What days of the week is your site available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
8.
Please provide additional details on your space if available.
(Optional)
i.e. size of parking lot, ability to block off section of parking lot for drive-up, square footage inside, number of entrances/exits in parking lot
9.
Approximately how many eligible people associated with your agency (clients, staff, eligible family members of clients/staff) may be interested in coming to your site?
Please note sign-ups will not be exclusive to you unless you can fill 350 slots.
10.
How many volunteers can you provide?
(not required)
Current Progress,
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