MONKEYPOX VACCINE

Ask Us About TELEHEALTH

Please fill out this short form to be contacted by Care Point to make a vaccination appointment.

We use phone contact exclusively to schedule appointments, so please make sure you put the number you can best be reached at.

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Phone Number(Required)

We provide services to those without insurance. It won't disqualify you from making an appointment.

Do you have insurance?(Required)

Yes

Name of Insured

Relationship to Insured

Self

Spouse

Child

Other

Name of Insurance

Secondary Insurance

Employer Name

Employer ID

Insurance ID#

Medicaid ID#

2200 S. Monroe Street
Tallahassee, FL 32301

Monday 8:00am – 5:00pm

Tuesday 8:00am – 5:00pm

Wednesday 8:00am – 5:00pm

Thursday 8:00am – 5:00pm

Friday 8:00am – 5:00pm