Long Island Vaccine Finders Form
Starting on April 6th, everyone who is over the age of 16 will be eligible for a COVID-19 vaccine. We will still continue to prioritize those who are older and have an underlying condition. It may take longer for us to get to your request.

We receive your submission of our form and process it by the order as they come in. Once we get to you, which can take a few days, we will work to find an appointment that is anywhere from 0-3 weeks, depending on your request. Once your appointment is created, you will receive a confirmation from us and also your ticket from the NYS Health Department.

We prioritize individuals who are 65+ and/or at high risk for COVID-19.

Before filling out this form, please verify that you are eligible through the New York State Eligibility Tool here: https://am-i-eligible.covid19vaccine.health.ny.gov/Public/prescreener

After filling out the NYS Form, it will tell you whether or not you are eligible for an appointment. NYS will verify to make sure you are eligible, you will NOT receive a vaccine from the state if you're not eligible.

You must be 18 or older to submit a request with us. If under 18, you must have parental permission to submit this form.
Which site would you like to be booked at? Please check all which work for you. *
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Please inform us on any dates/times/days of the week where a vaccine appointment will NOT work for you. If any day is okay, please leave blank and skip this question.
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