Register for COVID Vaccination Information
The state has created a vaccination phasing plan that the city is required to follow. You can see the full plan at
www.mass.gov/covidvaccine
.
Please answer all the questions below, and we will contact you once a vaccine is available within the phase you qualify for. No vaccines are permitted to be given out prior to the phase in which you are eligible.
* Required
Email address
*
Your email
Contact Information
First and Last Name
*
Your answer
Phone Number
*
Your answer
Can we text you at the phone number provided
*
Yes
No
Full Address
*
Your answer
Qualifying questions
1. Do you have any of the following qualifications for Phase 1?
*
Choose
I am not eligible in any of these categories.
Employed health care worker dealing directly with COVID, a PCP, SANE, or skilled nursing rapid response
Living or working in a long term care facility, rest home, or assisted living
Emergency first responder
Live or work in any form of congregate care setting
Home-based health care worker
Employed health care worker not working directly with COVID.
2. If the answer to Question 1 above was yes, please provide more details
Your answer
3. Your age
*
Your answer
4. Do you have a "co-morbid condition"?
*
Visit the following site for a list of such conditions:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
. You will be required to provide proof of condition.
I have not been diagnosed with a co-morbid condition
I am diagnosed with 1 co-morbid condition
I am diagnosed with 2 or more co-morbid conditions
5. Are you employed in any of the following fields?
*
Early education or K-12
Public Transit, utility
Grocery, food, beverage, agriculture, restaurant, cafe, convenience store, meatpacker, food pantry workers, or other food services,
Consumer goods, retail
Sanitation, public works and public health workers, vaccine development workers
Transportation: Uber/Lyft/ride share services, pharmacy delivery drivers, passenger ground transportation industry
Water and wastewater utility staff
Court system workers (judges, prosecutors, defense attorney, clerks), other than court officers who are listed under first responders
I am not employed in any of these fields
Retired
Other:
Do you have any other reason besides those listed above that you believe you would qualify under the state regulations for Phase 2 of vaccinations?
Your answer
Are you able to leave your house to receive a vaccine?
*
Yes
No
Maybe
A copy of your responses will be emailed to the address you provided.
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