COVID VACCINE REQUEST FORM
We’re here to help ANYONE that LIVES IN NYC OR WORK IN NYC AND IS ELIGIBLE.

*Please do not stop trying to get an appointment on your own, this is an additional effort and not a guaranteed appointment. When we secure an appointment you WILL be contacted by a volunteer. <3

To be fully transparent, we just really want to help people. We’re both pretty tech savvy and know the system can be a bit complicated. Specifically for seniors of those who maybe need help in Spanish or Portuguese - please reach out!

 We don’t have tricks or secret links, we’re just fast typers!

* WWW.TURBOVAX.INFO is an amazing tool in case you're not familiar with it - best way to find out about available appointments!

Can't wait to have our lives back to normal!
-Cat & Tracy

*All data (besides first and last name) is deleted after booking your appointment. Full name is kept for tracking purposes.

*”By submitting this form, I confirm my understanding that we are just trying to help out. No guarantees of any kind are being made, I consent to use of my personal information to make vaccine appointment(s) and I release everybody helping out from any and all claims whatsoever.”
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Email *
DO YOU LIVE OR WORK IN NYC?? AS OF NOW WE CAN ONLY HELP PEOPLE THAT LIVE OR WORK IN NYC AND ARE ELIGIBLE FOR VACCINE  - SORRY. If you do not qualify we won't be able to help, sorry! *
How are you eligible? *
FIRST NAME *
LAST NAME *
DATE OF BIRTH *
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DD
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YYYY
ADDRESS - Please enter full address, including zip code. If anything is missing we can't help. *
PHONE NUMBER *
ALLERGIES? *
WILLING TO GO TO ANY BOROUGH FOR APPOINTMENTS? *
AVAILABILITY *
Required
PLEASE LET US KNOW IF THERE ARE ANY DAY OR TIME THAT WE SHOULDN'T BOOK YOU AN APPOINTMENT. ANY NOTES? FEEL FREE TO WRITE ANYTHING HERE! *
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