Monroe County, NY COVID-19 Vaccine Registration Form

This form is for all vaccine eligible individuals who live in New York State.

Individuals 12-17 years old must have a parent/legal guardian with them to consent in person. Only Pfizer has been approved for individuals 12-17 years old.

* Required Fields

Confirmation of appointment will be sent to this email.
Available date/time Unavailable Selected

Recipient

Eligibility Group
Bring proof of eligibility with you to appointment!
Emergency Contact (optional)
Primary Care Provider (optional)
Screening Questions
Antibody therapy and convalescent plasma for COVID-19 is a medical treatment provided to some people with COVID-19 infection.
This allergy does not apply to mild allergic reactions such as rash only and does not include allergies that are not related to a vaccine (for example it does not include allergies to: pets, venom, environmental, latex or oral medications).
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