Mobile unit requests for Lynchburg City and Amherst, Appomattox, Bedford and Campbell Counties.

Our community has a variety of free, mobile options available for COVID-19 vaccine distribution. Completing this form will help us determine the best option for your request. You will receive a response to your request within 5 business days. Thank you for your desire to help increase vaccination rates in our community. 

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* 1. Event Location Name

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* 2. Location Type (i.e. school, LTCF, private business, government facility, etc.)

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* 3. Address of event

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* 4. Date for mobile vaccination event

Date

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* 5. Time range requested (i.e. 9am-noon, 1pm-6pm)

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* 6. Please provide a description of the vaccination event you would like to have including target audience, type of event, location description, etc.

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* 7. Is there a specific brand (Pfizer, Moderna, J&J) and/or type (1st dose, booster, 5-11, etc.) that you would like to target? If yes, please describe.

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* 8. Estimated number of doses, to include walk-in and/or by appointment

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* 9. Contact information-please provide name, phone and email address

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