COVID-19 Vaccine Form

Thank you for your interest in receiving your COVID-19 vaccine.

Lakeland Regional Health is administering COVID-19 vaccines, designated by the state for those 16 years and older.

To be called for an appointment, please complete the form below.

Please note that there are no out-of-pocket costs for the vaccine, regardless of whether or not you have insurance or your type of insurance.

COVID-19 Vaccine Form