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Interest Form for In-Home Vaccinations for Fully Homebound New York City Residents Only

Note:  Out of an abundance of caution, all Johnson & Johnson vaccine administration in NYC is currently paused, which includes the suspension of in-home vaccinations for homebound New Yorkers. For more info, visit nyc.gov/covidvaccine.

New York City is providing in-home Covid-19 vaccinations (Johnson & Johnson) to eligible NYC residents who are fully homebound, have not already been vaccinated, and do not already have access to a vaccination program.

New Yorkers who believe they are eligible for an in-home vaccination can express interest using the form below. The City will use this information to call back to further discuss eligibility for the program.

Date of Birth

Alternate Contact Full Name

Eligibility Attestation (check all that apply)

Consent

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