[ NYC] COVID-19 Vaccination - Homebound Residents

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

New York City is vaccinating City residents at home with the COVID-19 vaccine if they are 75 years or older, have a disability, are fully homebound, are a NYCHA resident, are an employee or retiree of the City of New York who lives in New York City, or have been referred by my union, a City partner or a City vaccination team member. Any eligible New Yorker requesting the vaccine through the in-home vaccination program will now have the option to request their vaccine brand preference (Pfizer, Moderna, or Johnson & Johnson).

Please fill out this form if you are eligible and 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 to discuss the program and your eligibility. It may take a few weeks to receive a call from the City.

Check all that apply

I am 75 years old or older

I am a person with a disability

I am fully homebound

I am a NYCHA resident

I am an employee or retiree of the City of New York

I was referred by my union, a City partner, or a City vaccination team member

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

First Name

Middle Initial

Last Name

Street Address

Apt. or Unit #

City

State

Zip Code

Phone Number

Alternate Contact Phone Number

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