Vaccine Eligibility

On 2/15/21, Adults New Yorkers of any age with qualifying comorbidities or underlying health condition(s) will be eligible to receive the COVID-19 vaccine. You are required to have a letter from your provider verifying your eligibility.

If you need a vaccine eligibility letter, please fill out the form below and indicate how you’d like to receive the letter. Please allow 3-5 business days to process your request.

First Name

Last Name

Phone Number

Provider Name

Please indicate how you would like to receive your vaccine eligibility letter:

Mail to address on file

Secure email

Send to Patient Portal

Email Address

On what grounds do you think you are eligible?

Additional Comments:

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