First Dose Appointments for COVID19 Vaccine
!!PLEASE READ THIS VERY CAREFULLY!!
Delaware is currently in Phase 1a in its allocation plan. ONLY long-term care facilities (Skilled Nursing Facilities, and Assisted Living Facilities), and Health care personnel (Hospitals, Ambulatory Sites, Home Health, Pharmacies, direct patient care, Public Health, and Direct care-providers), First responders, and People age 65 and above can receive the COVID-19 Vaccine. If you do not belong to one of the categories mentioned above, PLEASE DO NOT SCHEDULE AN APPOINTMENT. Also please don't schedule multiple appointments, if you would like to cancel or reschedule please email us at email@example.com. PROOF OF EMPLOYMENT AND AGE WILL BE REQUIRED DURING YOUR VACCINE APPOINTMENT.
If you are not able to make an appointment or the time slots are grayed out that means no open time slots are available. Please check this form for updates as appointment cancellations occur. If you are having any issues please contact us at firstname.lastname@example.org. PLEASE DO NOT CALL US. Thanks.
Date Of Birth
What is your occupation
None of the above
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
You are not eligible to get the COVID-19 Vaccine yet. Please check the State's website for updates
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