COVID-19 - Pacific County Public Health and Human Services 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the designated field. This is essential for identifying your appointment.
  3. If applicable, provide your case number to help streamline the process.
  4. Fill in your phone number and email address. If you do not have an email, ensure you provide a Safe Contact Number for follow-up communication.
  5. Indicate whether you need an interpreter by checking 'Yes' or 'No'. If 'Yes', specify the language required.
  6. Select the specific documents you wish to review by checking the appropriate boxes. This helps us prepare for your appointment effectively.
  7. Provide any additional information that may assist us during your appointment in the designated section.
  8. Indicate your availability for appointments by answering the questions regarding convenient times within the next week.
  9. Once completed, return this form via email, mail, or in person as specified at the bottom of the form.

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