top of page
Center_Glennburke.JPG

Clinic REGISTRATION FORM

Clinic Days Are Mondays, Wednesdays, & Thursdays, (12pm-6pm)
For MPOX (monkeypox) vaccine clinic dates and other questions, please call our clinic between 12pm-6pm, Monday thru Friday 
at 510-781-2639
Schedule your appoint by completing the form below.

Have you tested postive for Covid-19 in the last 14 days?
What is your gender identity?
What is your sexual orientation?
Are you low-income?
Please choose one or more of the following services:

Click here for income guidance

bottom of page