COVID-19 Vaccination
Important Info
moderna covid-19 vaccine
Read before submitting your application.
New York State Eligibility
I understand that vaccine supply is currently limited and, therefore, subject to strict prioritization in accordance with Centers for Disease Control and New York State Department of Health directives. With that understanding, and with the understanding that I will have to supply proof of my eligibility, I hereby certify under penalty of law that:
I understand that vaccine supply is currently limited and, therefore, subject to strict prioritization in accordance with Centers for Disease Control and New York State Department of Health directives. With that understanding, and with the understanding that I will have to supply proof of my eligibility, I hereby certify under penalty of law that I belong to one of the below priority groups eligible for vaccination:
- Individuals age 18 and older are eligible to be vaccinated, in addition to all previously eligible
groups.
As part of New York’s COVID-19 vaccine administration program, the New York State Department of Health is deploying the New York State COVID-19 Vaccine Form, a form that will request all individuals across New York State to self-report select demographic data such as occupation, race, and ethnicity prior to vaccine administration. This information is critically important for tracking vaccination progress throughout the State and ensuring appropriate vaccine distributions in all regions of the State.
You must fill out the data capture form before administration of the vaccine at Park Chemists. You must show your email confirmation from New York State to Park Chemists prior to being vaccinated. Without this confirmation, you CANNOT be vaccinated by Park Chemists.
The New York State COVID-19 Vaccine Form is expected to take less than 2 minutes to complete and can be found in the following link: vaccineform.health.ny.gov
Park Chemists Application Process
- The online COVID-19 Vaccine Form from Park Chemists follows a 3 step process:
1. Patient Information, Questions, and Consent
2. First Appointment Scheduling
3. Second Appointment Scheduling - Your second vaccination appointment must be 28 days after your first injection. Please make sure you schedule both of your vaccination appointments within the appropriate amount of time advised. Failure to comply will result in voiding your application and appointment requests.
- The day before your second appointment, you will receive an email requesting a new consent form. You are required to supply consent for your second appointment and re-answer patient questions to ensure up-to-date information. Please fill out the supplied form prior to arrival.
- Scheduling an appointment does NOT guarantee service of vaccination due to allocated supply. A Park Chemists representative will contact you prior to your appointment date to confirm your appointment.
- YOU WILL BE RECEIVING THE MODERNA VACCINE
Park Chemists Application Process
- The online COVID-19 Vaccine Form from Park Chemists follows a 2 step process:
1. Patient Information, Questions, and Consent
2. Appointment Scheduling - You will be receiving the Johnson & Johnson vaccine
- Scheduling an appointment does NOT guarantee service of vaccination due to allocated supply. A Park Chemists representative will contact you prior to your appointment date to confirm your appointment.
By continuing to the application, I agree that I have read this page in its entirety.