COVID Vaccine Registration

SpringVale Health Centers

204 S. Bellevue Ave., Dover, Ohio 44622

(formerly known as Community Mental Healthcare)

COVID-19 Vaccine Registration Sign Up

PLEASE READ BEFORE SUBMITTING REGISTRATION FORM

Information on Moderna COVID-19 Vaccine

Please read before submitting registering:

  1. SpringVale Health Centers (fka: Community Family Health Center) receives a limited supply of vaccines and we are distributing them according to the guidelines established by the Ohio Department of Health.
  2. If you have been scheduled to receive the COVID-19 vaccine with another agency or pharmacy, do not accept an appointment at SpringVale Health Center: Bellevue Ave.
  3. If you are unable to keep your vaccination appointment, please call us at 330.365.1781 right away.
  4. Our office staff will call you when it is your turn to receive the vaccine.
  5. Please only fill out and submit the form once.
  6. Please bring your vaccine card, if applicable.
COVID Fact Sheet
Moderna Fact Sheet
Pfizer Vaccine for Ages 5-11 Fact Sheet