[ NYC] COVID-19 Vaccination - Homebound Residents

All New York City Residents Can Get the COVID-19 Vaccine at Home

New York City is offering in-home COVID-19 vaccinations to any City resident who requests one. Any New Yorker requesting in-home vaccination will now have the option to request their vaccine brand preference (Pfizer, Moderna, or Johnson & Johnson).

Please fill out this form if you are interested in receiving the vaccine at home. Even if you received your first dose of Pfizer or Moderna through a different program, such as a clinic or mobile vaccination site, you can still receive the second dose at home. Select “second dose” and then choose the vaccine brand of your first dose when prompted. A third dose of the Moderna or Pfizer vaccine is available for people with moderate to severe immunocompromising conditions.

Your completed form will be shared with City agencies coordinating this effort, such as the Vaccine Command Center and the New York City Department of Health and Mental Hygiene for the purposes of scheduling and receiving a COVID-19 vaccination, and for vaccine program evaluation. You should receive a call within one week from one of the City’s in-home vaccination providers to schedule an appointment.

Please submit only one form, unless you submitted a form over two weeks ago and have not heard from us. Caller ID might not include the provider name. Please answer all calls so that we can reach you.

What dose are you looking to get?

*A third dose of Moderna or Pfizer vaccine is recommended for people with moderate to severe immunocompromising conditions resulting from a medical condition or treatment, such as:

Active treatment for cancer
Received an organ transplant and are taking immunosuppressive therapy
Received a stem cell transplant within the past two years
Moderate or severe primary immunodeficiency
Having advanced or untreated HIV
Active treatment with a high dose of corticosteroids or other drugs that moderately or severely weaken your immune system

You will be asked to complete a form to attest to immunocompromised status at time of vaccination.

Which vaccine brand did you receive for your First Dose? (Note: You must receive the same vaccine brand you received for your First Dose)

Which vaccine brand do you prefer?

Which vaccine brand did you receive for your First Dose? (Note: You must receive the same vaccine brand you received for your First Dose)

Are you 75 years old or older; a person with a disability; or fully homebound?

First Name

Middle Initial

Last Name

Street Address

Apt. or Unit #

City

State

Zip Code

Phone Number

Alternate Contact Phone Number

I consent to the following:

I agree to share the above information with the City and its partners and that a representative may contact me about my interest in this program.

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