Bay Area Community Health is now offering COVID-19 vaccines to patients and community members 65 and older or those who follow county guidelines listed below. If you do not meet the listed requirements, please do not contact BACH or fill out these forms. You will be able to register for a vaccine on a future date. Look for more information soon.
― Healthcare workers who work in Santa Clara County are also currently eligible
― Healthcare Workers
― People ages 65+
― Food and Agriculture Workers
― Emergency Services workers
― Education/Childcare workers
Self-Declaration of Vaccine Eligibility (Attestation) Form
You will not be seen if the form is not filled out beforehand.