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The original item was published from 2/4/2021 2:20:47 PM to 5/19/2021 1:02:58 PM.

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Posted on: February 4, 2021

[ARCHIVED] COVID-19 Vaccination Interest Form Now Available in San Joaquin County

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Stockton (February 3, 2021) – San Joaquin County residents who want to receive the COVID-19 vaccine can now submit their contact information through an online interest form to be notified when doses are available for their tier. The COVID Vaccine Interest Form is available at

“We are excited to announce the vaccine interest form and provide a way for people to take action and express their interest in the vaccine," said Dr. Maggie Park, San Joaquin County Health Officer. "We have heard from individuals in our community who are eager to receive the vaccine and they would like a way to provide their information. We are hopeful this will help us organize and coordinate our efforts to distribute the vaccine according to the outlined phases. We encourage everyone to be patient with us as we work through the phases and distribute the vaccine to those who are eligible within the current phase." 

The form, in both English and Spanish, takes about five minutes to complete and asks for basic information like name, email, zip code as well as information relating to which vaccination phase or tier the individual is in. At the conclusion of the interest form process, the individual will receive a confirmation number, which should be saved to register for future events. Individuals with questions, who need assistance completing the form, or need help registering for vaccine events can contact 2-1-1. 

"I am very excited to announce the availability of the interest form which will allow everyone in the county to register their interest in a vaccine," said Tom Patti, Chair of the San Joaquin County Board of Supervisors. "This new form will help our seniors and those in the other tiers eager to get the vaccine. In addition, the form will allow the County to contact residents and provide updates regarding the availability and scheduling. The County is working to provide vaccines to our residents and this registration form will allow us to quickly reach out to those that are eligible and get them an appointment at a later date by contacting them directly through e-mail or by phone." 

Individuals without a home address may use the address of any San Joaquin County based organization that has provided them support services in the past. If no other address is available, individuals may use the main San Joaquin Public Health Services location: 1601 E. Hazelton Ave, Stockton, CA 95205. If an individual does not have an email address or text-capable cell phone, they may use the information of a caregiver, family member, or friend. 

Vaccination appointments, while still limited, are being expanded to some in Phase 1B Tier 1 in the coming days and weeks. Priority groups, as laid out by the California Department of Public Health, will be used to make appointments. Completing the interest form will allow San Joaquin County officials to contact residents directly when a clinic is scheduled for their priority group. Filling out the form does not place a resident ahead of someone in a higher priority group.

It is important to note that if other vaccine events are available to eligible residents, that they should take advantage of those opportunities and not wait to be contacted by the County. The State of California is developing a similar system,, but it is currently not operational in much of the state. More information about that system will be released as it becomes available. To see other providers of the vaccine in the County, please visit

Interest Form FAQ [pdf]

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