Please complete the form below in order to be placed on the waiting list
for receiving the COVID-19 vaccine from San Luis Valley Health.

SLVH VACCINE CLINIC LOCATIONS

8:00 A.M. - NOON

Wednesdays - Stuart Ave Clinic in Alamosa

Thursdays - Monte Vista & La Jara Clinics

Fridays - Antonito Clinic

For registration changes or questions, please call (719) 587-1355 during
normal business hours or complete the form below (you do not need to do
both, but please call to cancel if you register elsewhere).

SLVH receives the Moderna vaccine (which requires a second dose 28 days
later) and can only vaccinate those who are 18 years of age and older.

Please bring
this form to your appointment.
Aqui is the form in Spanish.



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