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In-Home Vaccination Program

Please complete the form below if you would like to be contacted by Ulster County Department of Health for a homebound vaccination.

If you have any questions regarding homebound vaccination appointments, please contact Ulster County Department of Health at 845-340-3150.

First Name

Last Name

Date of Birth *

Phone *

Address *

Please note that a physical street address is required for the homebound visit.

City *

Zip Code *

Address 2

State *

Preferred Day of the Week *

Monday
Tuesday
Wednesday
Thursday
Friday

Vaccination Type *

Moderna
Pfizer
1st Dose
2nd Dose
3rd Dose
Bivalent Booster

Comment

(845) 340-3000 - 244 Fair Street, PO Box 1800, Kingston, NY 12402

© Ulster County Government - 2023