COVID-19 Vaccine Interest Sign-Up

The Philadelphia Department of Public Health is working to roll-out vaccine to Philadelphia Residents in a Phased Approach. The purpose of this form is to gather information from individual Philadelphia Residents about their interest in receiving COVID-19 vaccination within Philadelphia County. The form is confidential. For issues related to the COVID 19 Vaccine interest form, please contact covid@phila.gov.

SIGN-UP FORM