COVID Phase email

**THIS IS NOT A WAIT LIST**

If you would like to recieve an email notification of appointment availablity based on eligibility, please provide information below.

Please chose the SINGLE most accurate option under the phase that you are eligible under. You will be required to provide proof of eligibility.

If you are unsure which phase or sub group you belong to, please review the MA Phase overview before proceeding.

Name*

First NameLast Name

Email*

example@example.com

Phone Number

Phase 1 (all eligible)

Healthcare WorkerFirst ResponderLTC resident

Phase 2

Individuals age 75+Individuals age 65+, individuals 18-64 with 2+ comorbidities &/or residents and staff of low income and affordable senior housingK-12 educators, child care workers and school staffOther workers (public works, grocery, retail, food service, transportation)Individuals age 55+Individuals with one co-morbid condition

Phase 3

General PublicOther