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Vaccinate Central Virginia: Screening & Encounter Form
Click on the image below to access the COVID-19 VACCINATION SCREENING & ENCOUNTER FORM. Please download the PDF form and bring with you to your vaccine appointment along with your identification. If you wish, you can save time and fill out the fillable PDF form before you print.
Remember you will not receive a vaccine without an appointment. Having a completed form does not mean you will receive a vaccine.