Vaccine Interest Forms – Baltimore City – For Seniors and People with Disabilities

Appointments are opening regularly, eligible Baltimore City residents are encouraged to fill out a form below!

 Currently, the Baltimore City Health Department Offers two Vaccination Interest Forms for Baltimore City Older Adults Aged 60 and up and Baltimore City residents with Intellectual or Developmental Disabilities.

These forms are NOT registration for COVID-19 vaccination. Please complete these forms so the Health Department can contact you when we have vaccination appointments available. Please complete a separate form for each person who is interested in receiving the vaccine and is in this category.

By completing and submitting this form, you are giving the Baltimore City Health Department permission to share your contact information with a healthcare provider. If you have questions, please email us at

·       Older Adult (60+) COVID Vaccine Interest Form

·       Intellectual and/or Developmental Disabilities COVID Vaccine Interest Form