Appointment Scheduling

Prior to completing this form please have the below available in order to fill out the consent form 

• Insurance card if applicable 
• Medicare Card (red white and blue card) for ALL Medicare beneficiaries
• State Identification Card

After you schedule your appointment, please visit New York State COVID-19 Vaccine Form (ny.gov)  to get NYS eligibility verification form 

***Patient must bring NYS ELIGIBILTY VERIFICATION LETTER to appointment*** 

Failure to bring this letter can result in a CANCELLED appointment

You Must Bring the following to your appointment: 

• Eligibility Verification Letter from NYS
• Insurance Card (Insurance, Medicare or Medicaid Card)
• State Identification Card