Covid Vaccine Registration Forms

The forms are fillable online, print and sign it, then bring it to our clinic 2 days before the vaccination date 

to be pre-enrolled and avoid long wait times.

AN EMAIL ADDRESS IS REQUIRED TO COMPLETE THE REGISTRATION

Alternatively you can email your signed form to clinic@bartz-altadonna-chc.org

If any information is missing, you will be asked to park on the side and complete the registration form

losing your spot on the line and having to wait longer

KERN COUNTY RESIDENTS CLICK HERE FOR YOUR MODIFIED ELIGIBILITY CRITERIA