Vaccination Notification Request Form

The purpose of this form is to gather contact information for individuals wishing to receive the COVID-19 vaccine as it becomes available.  Currently, the COVID-19 vaccine is being rolled out to specific groups in phases defined by the New York State Department of Health [See if you are in a qualifying group].

This is not to pre-register for a COVID-19 vaccination appointment. After you fill out the Vaccine Notification Request form, your information will be added to a County mailing list, and you will receive email updates from Greene County as to when you may be eligible to receive the vaccine, including on how to register for an appointment.

Now accepting notification requests for 18+

Please note: The information you submit is for the sole purpose of gathering contact information to provide public outreach for the COVID-19 vaccine. The information submitted on this form will only be used for COVID-19 vaccine purposes. The information you submit will remain private.

Once you have filled out and submitted the COVID Vaccine Notification Form, You will be notified as soon as vaccines are available to you through either the Greene County Public Health Department or your local Pharmacy. 

PLEASE DO NOT submit the form more than once, as duplicates are systematically removed, and multiple submissions WILL NOT improve your chances of getting a vaccine any sooner.

Please be patient, as there are currently far fewer vaccines available than those eligible to receive them. 

 


    *You may select multiple reasons for wanting the vaccine. On a phone, please tap all that apply. On a computer, please hold Ctrl while clicking all that apply.

    Persons with Comorbidities and Underlying Conditions Must Provide a Doctor's Letter or Medical Information Evidencing Comorbidity or A Signed Certification as Determined by Greene County.