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Provider Enrollment for Employee COVID-19 Vaccination

If you are a healthcare provider in Clayton County and you do not already have access to COVID-19 vaccine, the Clayton County Health District may be able to assist with the vaccination of your employees.

PLEASE COMPLETE THIS FORM! Completion of this survey will help us identify healthcare workers in need of vaccination. Once we have an adequate supply of vaccines, we will follow up directly with the point of contact listed on the form.

Completion of this survey is not a guarantee that you will be placed on a priority vaccination list. Priority status is determined by the Georgia Department of Public Health and based on recommendations by the Advisory Committee on Immunization Practices.