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Vaccination Appointment Cancellation Online Form

  1. Vaccination Appointment Cancellation Request

    This form is to request cancellation of a vaccination appointment that has been scheduled at either of the PORTER COUNTY HEALTH DEPARTMENT Vaccination Locations ONLY!

  2. All fields in this form REQUIRE an answer. Please be sure to verify that you have answered all questions before you submit this form. You will not be able to submit this form unless all questions are answered.
  3. Are you cancelling the appointment for yourself or for someone else?*
      1. Appointment Information
      2. Please enter in MM/DD/YY format
      3. At Which Porter County Health Department Location Is The Appointment Scheduled For?*
      4. You are almost done. Just click on Submit below and you will be directed to a submission confirmation page. If you are NOT redirected, it usually means that you have not answered all questions. Please scroll up and answer any highlighted questions then click on Submit or Submit & Print again.
      5. Leave This Blank:

      6. This field is not part of the form submission.