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COVID-19 Vaccine Survey for Healthcare Providers ONLY

  • Please fill out this survey and your office will be contacted with next steps regarding COVID-19 vaccination. All staff in an office are eligible. This survey is for San Joaquin County providers only. If you have received this survey from another source, please do not respond again. If you have already been contacted by another entity for vaccination, then do not fill out this survey.

  • COVID-19 Vaccine Survey Form for Healthcare Providers

Healthcare providers who want to receive and administer the COVID-19 vaccine must be enrolled in:

  1. CalVax– All California healthcare providers must enroll in the California COVID-19 Vaccination Program electronically through CDPH’s provider registration and enrollment system at the CalVax website. CalVax is a centralize system that allows providers to order vaccines, update account information and manage vaccine reporting tasks. Enrollment applications must be thoroughly and accurately completed by each enrolled organization and corresponding locations. COVID-19 vaccines and ancillary supplies will be procured and distributed by the federal government at no cost to enrolled COVID-19 vaccination providers.
  2. An immunization registry that can submit data to the California Department of Public Health every 24 hours (e.g. CAIR2). If you are not, please sign up for our regional registry, Healthy Futures.
For more information, email sjc_iz@sjcphs.org.