Waitlist Form

Add to Covid-19 vaccination Waitlist

You will get an email from medctrvaccine@gmail.com if appointments are open or we may call you to fill in no-show or cancelled appointments. Do not reply to these emails as they will not be read or replied. If you get an email go to our website at medicinecenter.nyc and book your appointment.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Which borough of New York City you live in?*

BronxManhattanQueensBrooklynStaten Island
Should be Empty:

Add to Covid-19 vaccination Waitlist