Michigan Vaccine Angels

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This is a volunteer-run effort to help people make a COVID19 vaccination appointments. We have made 3,500+ appointments so far and have been covered by all local news stations. Simply fill out the form, and we will call/text you back with your appointment details!

1. If you just need resources and want to make an appointment yourself, you can find all the links to make an appointment here:
https://cutt.ly/GetVaccinatedStartHere

2. Please understand that we are all volunteers, not medical staff, and are using publicly available information to make appointments for people in our spare time. Please be kind to our amazing volunteers.

DISCLAIMER: No Vaccine Angel should ever ask for your Social Security Number or money. If anyone does DO NOT GIVE IT TO THEM.

Thanks!
-Katie, Liz and Sharlene

Concerned about who is getting your information?
We worked hard to only ask for the bare minimum amount of information, and then that information is temporarily stored in a restricted sheet that only a small number of vetted volunteers have access to. It will only be used to schedule your vaccine appointment, and then it is deleted permanently. I encourage you to Google the Michigan Vaccine Angels to see some of the local news coverage which goes into more detail about what we do and our security measures.

Find an appointment before we do?
Please remove yourself from our list! We work hard for every appointment. https://cutt.ly/RemoveMe

Email *

Full Legal Name: * *

Address (include street address, city, and zip code). If sharing this makes you uncomfortable, you can just put zip code.

Counties/Areas you work and/or live in:

Wayne

Oakland

Macomb

Kent

Genesee

Washtenaw

City of Detroit

Other:

Clear selection

Phone number (XXX)-XXX-XXXX *

Which ways are we able to contact you *

Text

Call

Other:

Required

Please check the category which you belong in: *

18+

12-17 (minors please add your parent's phone number after your birthday)

Other:

Date of birth (mm/dd/yyyy). NOTE: If providing your birthday makes you uncomfortable, you can provide your age here BUT you will have to correct it in person so your vaccination record is correct. *

Please check the following if it applies to you *

I only want Pfizer

I only want Moderna

I only want J&J

I need a second Pfizer dose (add date of first shot in next question)

I need a second Moderna dose (add date of first shot in next question)

None of the above - I will be happy with the first vaccine available to me!

Other:

Required

What days/times work well for you? What day/times would you like us to avoid?

How far are you able to drive? We will strive to get as close to your home address as possible. Also list any transportation issues here (homebound etc.)

Are you registering multiple people / do you wish to share an appointment date/time with another person? *

Yes and I will fill out another form for them (or just filled out another form for them)

Who is filling out this form? By typing your name, you acknowledge that we are vetted and screened volunteers who will have access to the info on this form ONLY to make you vaccine appointment. Afterwards, your information will be deleted permanently. Name of person filling out the form: *

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