Sign-up to receive an appointment.

La Clinica offers the vaccine to people living in Contra Costa county. Please provide your information to schedule an appointment. 

Question Title

* 1. What is your full name? 

Question Title

* 2. Phone Number:

Question Title

* 3. Date of Birth:

Date

Question Title

* 4. Are you a past or current LC patient (this will not affect your eligibility)?

Question Title

* 5. 7. Do you work in any of these fields? (Check all that apply)

Question Title

* 6. Are you Age 65+

0 of 6 answered
 

T