District 34: COVID - 19 Vaccine Request

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Thank you for your interest in receiving the COVID 19 vaccine! Eligible constituents of Senate District 34, if you need assistance in setting up an appointment to receive the COVID 19 vaccine, please fill out the form below and my team will get back to you as soon as appointments become available.

If you have any questions, you can contact our office at 718-822-2049 or email constituentservices@senatorbiaggi.com

With gratitude,
NYS Senator Alessandra Biaggi

Email *

Name of vaccine recipient *

Full Address (including zip code) *

Phone Number where you can be reached *

Date of Birth *

YYYY

Are you available to get the vaccine at any time? Please list your time limitations. *

How are you eligible for the vaccine? *

Age 16+

First Responders & Corrections Workers

Healthcare personnel

Essential Workers (Building Service worker, Grocery Store worker, etc)

Restaurant Workers & Restaurant Delivery Workers

Public-Facing Government employee

Not-for-profit workers who provide public-facing services

Residents & Staff at Long Term Care Facilities

Residents & Staff in Congregate Settings

Any comorbidity listed here: https://www.governor.ny.gov/news/governor-cuomo-announces-new-yorkers-comorbidities-and-underlying-conditions-can-make

In-Person College Faculty & Essential Staff

Teachers & Child Care Workers

Hotel Workers

Public Transit Workers

For-Hire Vehicle Drivers

Other:

Required

Have you already received the first dose of the Covid-19 Vaccine? *

Yes

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