Get Nys Covid 19 Vaccine Form

This guide provides clear instructions on how to fill out the Nys Covid 19 Vaccine Form online. By following these steps, you can easily provide the necessary information to determine your eligibility for the COVID-19 vaccine.

Follow the steps to complete your vaccine pre-screening form.

1. Click ‘Get Form’ button to access the online form and begin the process of filling it out.
2. In Section 1: About You, enter your first and last names as they appear on your identification documents. Provide your date of birth in the MM/DD/YYYY format and select your sex from the options available (Male, Female, Non-Binary, Prefer Not to Answer).
3. In Section 2: Contact Information, input your current residence address. Select your preferred language for communication from the options provided. Choose your preferred method of contact, either Text Message or Email, and provide the appropriate email address or mobile phone number based on your selection.
4. In Section 3: Additional Information, answer whether you work in a patient-facing healthcare or congregate living setting by selecting Yes or No. If applicable, choose from the specific settings listed. Also, indicate whether you currently reside in a congregate setting and select from the available options if you answer Yes.
5. In Section 4: Acknowledgment, check the box next to ‘I consent’ to confirm your agreement to the terms. This step is necessary to submit the form.
6. Review all entered information for accuracy, then proceed to submit the form. You will receive a notification indicating your eligibility for the vaccine based on the information you provided.

Complete your Nys Covid 19 Vaccine Form online to check your eligibility for the vaccine.