Join the Ro Pharmacy COVID-19 Vaccine Drive!
Please tell us if you'd like to get paid vaccinating your fellow New Yorkers in their homes. The COVID-19 Vaccine Drive will focus on vaccinating our underprivileged and most vulnerable population, who are less mobile. Sign up below if you're interested in learning more! We will reach out to you with more details when the Vaccine Drive begins!
Your name *
Your email address *
Your Phone Number *
What's your occupation? *
Do you hold active licensure in New York? *
Please share what specific licenses you carry and if you're licensed in other states as well *
Do you have an active BLS certification? *
Have you been fully vaccinated against Covid-19?
Clear selection
What zip code do you live in? *
Are you able to travel to all 5 boroughs of NYC? *
Are you able to travel to vaccine sites outside NYC? (Westchester and/or Long Island)?
Clear selection
How many days will you be able to dedicate to the vaccine drive? *
Do you have a car? *
How did you hear about us?
Anything else that we should know?
Submit
Never submit passwords through Google Forms.
This form was created inside of RO. Report Abuse