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Northern Nevada
Public Health

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

Please note this form is specific only to Healthcare related employers and businesses and not for the general population.

If your business type is listed in one of the upcoming priority groups, please sign-up here.

If you are 65 years or older, you can sign up for the waiting list by filling out this form online.

For more information about the COVID vaccine, please visit this link.

Facility Information

Facility address

Scheduling Information

Primary Facility Point of Contact Information


Secondary Facility Point of Contact Information