Cowlitz County Fire District 5

COVID 19 Vaccine Order Form

To order your COVID19 Vaccine, please complete the e-form fields below. Once your vaccine order has been received, a Cowlitz County Fire District 5 representative will contact you and setup an appointment to receive your vaccination.

The information you provide, will only be shared with appropriate agencies/organizations necessary to order your vaccine. For added security, we have secured our website with a SSL Certificate, to ensure the information you provide is secure and protected.

Notice: All form fields require appropriate information to be entered or selected, in order to submit your vaccine order.