The Philadelphia Department of Public Health is providing COVID-19 vaccine to all Philadelphia residents. Unfortunately, there is not enough vaccine in the city right now for everyone who wants it.
So the Health Department needs to make sure that people who are at the highest risk from COVID can get access to it first. This form will let the Health Department know that you are interested in receiving the COVID-19 vaccine, and make sure that people with the highest risk can get it first. If you cannot complete the form, please call the Health Department at (215) 685-5488 or email here.
For more details and to access the form, go here.