Schools and Childcare Order Form
If you are outside of Contra Costa County, please contact your local county Immunization program.
Please use this form to order Immunization Supplies. Please indicate address and contact information. Fax completed Order Form to Connie Ward at 925-313-6036 or fill-up Online Order Form and Submit.
Fax Order Form (PDF)
Online Order Form
for Contra Costa County School Districts only
For further information or assistance contact the Immunization Program at 925-313-6767.