COVID-19 vaccine resources and consent form

Bay Area Community Health is now offering COVID-19 vaccines to patients and community members. 
Vaccines are available to those who meet the below criteria:
  • You are eligible for a vaccine if you are aged 16 years or above.
  • Those aged 16-18 must be accompanied by a parent or guardian with written delegation (see parental consent form below).
  • Pfizer vaccine for 16-17 year olds is available at MVROP site on Tuesdays and Fridays ONLY.

To register:

  • Click on the box to the county below to select an appointment time and register on line. Complete as much requested information as possible.
  • Fill out below COVID vaccine packet and bring it with you to your vaccine appointment.

On day of vaccine:

  • Provide government-issued ID if you have it (ID is not required to get the vaccine)
  • Bring an insurance card (if you have insurance) on the day of your visit
  • Vaccination is drive-thru (walk-ups will be accomplished)
  • Please wear a short-sleeved or sleeveless shirt for the vaccine, OK to wear additional sweaters or jackets
  • Be prepared to stay 15-30 minutes after the vaccine for observation of possible side effects
Download
BACH COVID-19
Vaccine/Registration/Screening Consent Form:

English | Spanish | Simplified Chinese

To save time, fill out registration-screening-consent forms before you arrive at the vaccine site.
 

Schedule an appointment

Alameda County

510.770.8040

Santa Clara County

408.729.9700
Alameda County Registration
Santa Clara County Registration
MVROP Parking Lot
5019 Stevenson Blvd,
Fremont, CA 94538

Santa Teresa VTA

6360 Santa Teresa Blvd.
Enter at Santa Teresa
Blvd at San Ignacio Ave
San Jose, CA 95119

Vaccine Resources

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For further info call: 510.770.8040

For appointment cancellation, please call:
Alameda County: 510.252.6888

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