COVID-19 Vaccination Scheduling
For First Doses: Moderna Vaccine- You must be available for second dose 28 days after first dose. Pfizer Vaccine- You must be available for second dose 21 days after first dose. J&J Vaccine is now available. One dose, no follow-up needed.
Are you interested in having an appointment at OVAC Building or in home?
OVAC- 8 Clinton Ave. Ossining NY 10562
In home/ Homebound- you must call our building to confirm appointment. At home appointments will not be confirmed via jotform email.
Please choose a Vaccine.
Pfizer (5-11 only)
J & J
Which dose in your series is this?
Third/ Booster (12+)
Vaccinating Location: OVAC Building @ 8 Clinton Ave Ossining NY 10562
Please ring door bell at the entrance to the left of the garage doors.
Second Dose Appointment Date- Date will not auto populate for proper time rom first dose. Please double check to ensure your second dose appointment is correct.
First Name (Primer Nombre)
Last Name (Apellido)
Date of Birth (Feche de nacimiento)
Phone Number (Numero de telefono)
Please enter a valid phone number.
Email (Correo electronico)
Street Address (Direccion)
Street Address Line 2
State / Province (Estado)
Postal / Zip Code (Codigo postal)
If an extra dose is available or we have a cancellation on any given day would you like to be contacted last minute for a dose?
Yes please use the phone number listed above.
No thank you.
I acknowledge that my appointment may need to be changed based on available vaccine doses. OVAC will try its best to allow for ample notice of any changes needed.
Patient or Designee Signature
Ossining Volunteer Ambulance Corps Inc.
Limited Service Laboratory PFI: U384 CLIA: 33D2079047 COVID PIN # is 74688
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