Monroe County, NY COVID-19 Vaccine Registration Form

Edgerton R-Center - Public Link

FOR INDIVIDUALS CURRENTLY ELIGIBLE UNDER NEW YORK STATE GUIDELINES RECEIVING 1ST DOSE ONLY!
This link is for individuals who are currently eligible for vaccination in New York State for any reason scheduling a first-dose appointment for COVID-19 vaccination. If you are not able to self-attest to being eligible, please do not use this link.

* Required Fields

Confirmation of appointment will be sent to this email.
Edgerton R-Center - 41 Backus St., Rochester, NY 14608
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).
This includes tetanus, hepatitis A, mumps, flu or any other vaccine.
YOU WILL NOT BE ABLE TO EDIT THIS INFORMATION AFTER CLICKING THE SUBMIT BUTTON BELOW. PLEASE MAKE SURE ALL INFORMATION IS CORRECT.