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City of Lynchburg

sdcandm@lynchburgva.gov

900 Church Street, Lynchburg, VA, 24504, US

434-455-3800

Homebound Vaccine Registration Form

If you are homebound or otherwise medically unable to leave your home, you may sign up to have a vaccinator come to your home to administer the COVID vaccine. Please complete the information below and someone will call you to make an appointment that is convenient for you. This service is for residents of Amherst, Appomattox, Bedford and Campbell Counties and the City of Lynchburg only.

Have you received your first COVID vaccination?

If you answered yes, which vaccine did you receive?

Full Name

Full Address