Responsible Parties,

For your loved one to receive the COVID-19 vaccine, please fill out the form and return it in one of the following ways: 

     1. Email to Jocelyn:

     2. Fax: 434-846-3436

     3. Drop off to the facility

The vaccination will be done on January 28, 2021.  Please have the consent form to us no later than January 27th.

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