Please complete this form if you live or work in Delaware County and are interested in receiving the COVID-19 vaccine.
If you are in the age "16-64 with a medical condition" group*, that now identifies you as Phase 1A, and you completed the previous survey, please complete this form again. Delaware County is currently administering the Moderna vaccine which is approved for use in individuals age 18 and older. Chester County CANNOT administer the vaccine to anyone ages 16-17.
If you are completing this form on behalf of someone else, please enter the person's contact name and the best email for him/her to receive updates.
After submitting this form, you will receive regular updates on the current status of vaccine distribution in Delaware County.
You will be contacted to schedule an appointment as sufficient vaccine supplies arrive.
*Medical Conditions: Cancer, Chronic kidney disease, COPD (chronic obstructive pulmonary disease), Down Syndrome, Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies, Immunocompromised state, Obesity (BMI of 30 kg/m2 or higher but <40 kg/m2), Severe Obesity (BMI ≥ 40 kg/m2), Pregnancy, Sickle cell disease, Smoking, Type 2 diabetes mellitus