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In-Home Bivalent COVID-19 Vaccine Booster

The City of Evanston is working to reach all Evanston residents who are homebound due to medical conditions or are otherwise unable to visit a vaccine provider.
 
If you fit this criteria, please complete the form below so the City can coordinate an in-home vaccination. (If you know someone who fits this criteria, please complete the form on their behalf.)
The Evanston Health & Human Services Department and Illinois Department of Public Health have fully adopted ACIP and CDC recommendations for bivalent boosters.

The bivalent COVID-19 boosters have been authorized for people ages 12 years+ (Pfizer-BioNTech) and for people ages 18 years+ (Moderna) who have completed the primary series.

Bivalent vaccines can be used as a single booster dose at least two months following a primary series or booster vaccination.

By completing this form you are not scheduling an appointment but will be added to a list to receive updates on the booster shot process.

This survey is HIPAA compliant, meaning your health information will be protected.
1.First Name
2.Last Name
3.Date of Birth(Required.)
4.Email (Required.)
5.If you are submitting this form on behalf of someone else, please provide your contact information.