[ 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. 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 will receive a call from one of the City’s in-home vaccination providers to schedule an appointment. It may take a few weeks to receive a call.

Which vaccine do you prefer?

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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