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COVID-19 Vaccine Interest Form

January 22, 2021 by Mountain Family

Mountain Family Health Centers (MFHC) is working with Garfield County Public Health, our local hospital partners, and the Colorado Department of Public Health and Environment to ensure that everyone in our community has access to the vaccine who wants it. The state has a phased approach to providing the vaccination. The submission of the information in this form will allow us to identify in what phase you will be eligible for the vaccine, and once the state reaches that phase and MFHC has vaccine doses available, we will contact those who have expressed interest through this list. You do not have to be a patient of Mountain Family to sign up or receive the vaccine through us, but we do ask that you answer the questions below as completely as possible to assist us in our efforts. If you need assistance with this form or would like to speak to us, please call 970-945-2840.

Link here to sign-up .


Mountain Family Health Centers is a 501(c)(3) nonprofit Federally Qualified Health Center

OUR MISSION

We improve the health of our community by providing equitable and affordable medical, behavioral, and dental healthcare for all.


970-945-2840
contact@mountainfamily.org
(general questions only)
1905 Blake Avenue, Suite 101
Glenwood Springs, CO 81601