Penn Medicine COVID-19 Vaccine Interest Form
Penn Medicine is vaccinating patients on a limited basis, based on where they live, starting with those who are 65 and older (75 and older in Philadelphia) or who have certain pre-existing medical conditions. Our aim is to vaccinate members of our community in the most ethical, safest and quickest way possible.
The two vaccines currently being used are both 95% effective. If you are eligible to receive the vaccine, we encourage you to get it, or to speak with your provider if you have questions about side effects and whether it's right for you.
We will continue to work with local, state and federal governments to ensure our vaccine rollout is consistent with their guidelines.
If you would like us to keep you informed about the availability of the COVID-19 vaccine at Penn Medicine, please complete the form below.
Thank you for your interest in a COVID-19 vaccine at Penn Medicine. Please note that we currently have a limited supply of vaccine and are vaccinating patients who are most at-risk of serious illness from COVID-19 first.
We will keep you informed as our vaccine distribution plan develops and our supply increases. Please note that we are unable to schedule vaccine appointments for patients who call us at this time. We understand how important it is to you to receive a vaccine and are doing everything we can to vaccinate as many people as we can, as quickly as we can.
To fill out the form for another person, please click here to reset the form.