Request an appointment for COVID-19 testing or vaccine

Welcome to Norwalk Community Health Center’s COVID19 testing/vaccine request portal.

100% of our health center staff is fully vaccinated against the COVID19 virus, for the protection of our employees, our patients, our families, our neighbors, and the community.

Please complete the information below to schedule a COVID-19 test or vaccine. A member of NCHC will reach out to you to confirm your appointment.

Download the following form before your visit:

Patient Rights and Responsibilities: english | español

This is not an appointment or cancelation confirmation.

A NCHC staff member will contact you to verify the information submitted.
Hours of operation for NCHC are Mon-Fri 8:00-5:00 and Saturday 8:00-12:00.
Calls will be returned during our normal business hours.

If this is an emergency, please call 911.

Is this request for you?:(Required)

Is this request for a child or an adult?:(Required)

Parent name:(Required)

First Last

If appointment is for child.

Name of person for testing/vaccine:(Required)

First Last

Date of birth for person testing/vaccine:(Required)

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Phone# for NCHC to Contact:(Required)

Email:(Required)

Enter Email Confirm Email

Insurance Information:(Required)

Name of Medical Insurance:

Policy #:

Message to NCHC:

Anything you would like our representatives to know before contacting you?