Hoboken 1B -High-Risk - COVID-19 Vaccine

Hoboken Residents- 1B -High-Risk - COVID-19 Vaccine Interest Form
Please fill out the following information and you will be contacted by staff to schedule an appointment when available.

(Please do not submit this form more than once per person)

Must meet criteria below:

1A Category - First Responders, Uniformed Police & Fire, and Healthcare workers

or

Individuals at High Risk (Phase 1B)

Individuals aged 65 and older, and individuals ages 16-64 with medical conditions, as defined by the Centers for Disease Control and Prevention, that increase the risk of severe illness from the virus. These conditions include:
- Cancer
- Chronic kidney disease
- COPD (chronic obstructive pulmonary disease)
- Down Syndrome
- Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
- Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
- Severe Obesity (BMI ≥ 40 kg/m2)
- Sickle cell disease
- Smoking
- Type 2 diabetes mellitus
- Individuals who are pregnant and those in an immunocompromised state (weakened immune system) from solid organ transplant are also eligible but should follow CDC guidance and first discuss vaccination with their medical provider before receiving the vaccine.
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Please read this important information:
1. If you have been COVID-19 positive in the past 90 days you are NOT eligible to receive the vaccine at this time.
2. If you are currently taking blood thinners please check with your physician in advance. Some individuals may need to stop medication prior to vaccine administration.
3. Individuals on immune-suppressing medication should consult with their physician for vaccine eligibility in advance.
4. If you have received another vaccine in the past 14 days prior to your appointment you are not eligible to receive the vaccine. Please plan accordingly.
5. If you have ever experienced a life-threatening allergy to a medication, food, or vaccine speak with your physician.
6. You cannot receive the vaccine if you are currently ill.
7. If you are currently pregnant or breastfeeding please contact your physician.
8. Please contact your physician prior to scheduling an appointment with any concerns regarding your eligibility to receive the vaccine.
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Hoboken Residents- 1B -High-Risk - COVID-19 Vaccine Interest Form