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Immunization Materials
Schools and Childcare Order Form


If you are outside of Contra Costa County, please contact your local county Immunization program.

Instructions

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


Please select the items and indicate the quantity you would like to order.

  Item Description Quantity
Orders will be sent within Contra Costa County School Districts only

For further information or assistance contact the Immunization Program at 925-313-6767.