Form Center Module

Form Center

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▼Health & Human Services - Public Health

  1. County of Placer - Health and Human Services - Public Health Women, Infants, and Children (WIC)
  2. Placer County COVID-19 Vaccine Stakeholder Information

    Placer County health care workers who live or work in the county are no longer required to provide a point of contact to receive... More…

  3. Placer Safe Routes to School Pledge
  4. Public Health Covid19 Supply Order

    For Public Health partners unable to procure or locate supplies. Fill out and submit the form. If supplies are available you will be... More…

  5. Residential Care Facilities Vaccination Requests
  1. COVID-19 and/or Flu Pop-Up Vaccine Clinic Interest Form

    COVID-19 and/or Flu Pop-Up Vaccine Clinic Interest Form

  2. Placer County Public Health Partner Vaccine Allocations
  3. Placer Safe Routes to School Pledge (Spanish)
  4. Public Health Office Depot Order Form

    You should have supervisor approval prior to placing an order

  5. Smoke-Free Campus Reporting Tool