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Pitt County Health Department Forms

  1. COVID-19 Community Request to Host COVID-19 Vaccine Clinic

    This form is intended for community groups who would like to host a COVID-19 vaccine clinic at their location.

  2. Telemedicine (Telehealth) Consent Form

    The Telemedicine (Telehealth) Consent Form is used by patients who request to receive healthcare services from Pitt County Health... More…

  1. Pitt County Health Department Student Placement Application

    This form serves as a application for high school and college students requesting internships and / or other contact hours at Pitt... More…