Skip to form
NYC Logo

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

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.

Date of Birth

Alternate Contact Person

I consent to the following:

Be sure to verify that you are not a robot by using the Captcha tool at the below.
Having reCaptcha issues? Click here to reset the widget.