Vaccine Interest 1A - Jefferson County General Health District

500 Market Street
6th Floor
Steubenville, OH 43952

Vaccine Interest Form - Phase 1A

Which category do you work in or does your company fall under? *

Company/Agency Name *

Primary Contact Name *

Street Address *

City *

State *

Zip *

Primary Contact Phone Number *

Primary Contact Email *

Total Number of Staff to be Vaccinated *

Total Number of Residents to be Vaccinated

Time

If you are human, leave this field blank.

We accept payments by cash, credit cards, or check.

There is a $2.50 convenience
fee for credit card payments.

Hours of Operation

Sunday: CLOSED
Monday: 8 am – 4 pm
Tuesday: 8 am – 4 pm
Wednesday: 12 pm – 5:30 pm
Thursday: 8 am – 4 pm
Friday: 8 am – 3 pm
Saturday: CLOSED

Proudly Serving Jefferson County, OH

Steubenville
Toronto
Wintersville
Mingo Junction
Tiltonsville
Yorkville
Smithfield
Adena

Dillonvale
Bergholz
Amsterdam
Richmond
Mount Pleasant
Rayland
Irondale

Empire
Stratton
Pottery Addition
New Alexandria
Bloomingdale
…and the Surrounding Areas