COVID-19 Vaccine Interest Form
Thank you for keeping our community safe! We are glad that you are interested in receiving a COVID-19 vaccination. Once you complete and submit the online form and we will add you to a contact list so that we can reach out to you as each Phase 1b progresses. For additional information about the different Vaccination Tiers, please visit the following page from the State of California:
Filling out this form will put you on the contact list for vaccines. This is not scheduling your vaccine appointment. That will come later, as each Phase and Tier becomes eligible.
This form is to be completed for San Benito County residents ages 16 and above who are identified only in 1b Tier 1 and 2 of the vaccination plan. The State will be rolling out a system for those identified in a later group which is anticipated in the coming week.