If you are in need of assistance to sign up for a Covid-19 vaccine, please complete the form below at your own discretion.

Please be aware that the majority of appointments are being booked at NEW YORK STATE VACCINE SITES. We have very limited capacity for pharmacies at this time. Those requests will take MUCH LONGER, so you should continue to seek an appointment on your own.  

By submitting this form, you certify that the following statements are true:
1. This is my FIRST time filling out this form (duplicates will be deleted).
2. I do NOT already have an appointment scheduled for first or second doses.
3. I have TRIED finding an appointment on my own and need assistance.

*We do not take Vaccine Brand requests, as they may change by the day and per location.

Note: This is a voluntary submission of the below personal data. The purpose of this form is to only assist others.  Please be advised this information is not secured.

We are not medical professionals and highly recommend you speak with your doctor before scheduling an appointment. Additionally, we encourage everyone to continue trying to schedule their own appointments – this is meant to support, not replace, your efforts in obtaining an appointment.

If we can successfully schedule you, we will contact you directly with further information.