Oregon Health Authority - Technical Assistance Request Form - COVID-19 Primary/Booster Vaccination Needs Assessment

The Oregon Health Authority (OHA) would like to understand if you or your facility need help getting access to COVID-19 vaccine, including initial or booster doses. Please complete this form if you are:

-A person who is (or cares for) a home-bound individual
-An administrator of a long term or congregate care facility with residents or staff that need vaccine assistance

Please complete this form to let us know whether or not you need assistance with COVID-19 vaccinations and, if so, what OHA can do to help you. It should only take about 5-10 minutes to complete. 

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