The Philadelphia Department of Public Health is working to roll-out vaccine to Philadelphia Residents in a Phased Approach. The purpose of this form is to gather information from individual Philadelphia Residents about their interest in receiving COVID-19 vaccination within Philadelphia County. The form is confidential. For issues related to the COVID 19 Vaccine interest form, please contact firstname.lastname@example.org.
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635 W. Erie Ave.Philadelphia, PA 19140
P*: (215) 223-1890
F*: (215) 223-1959
105 A East WingP.O. Box 202197Harrisburg, PA 17120-2197
P*: (717) 772-2004
F*: (717) 780-4784