Harford County COVID-19 Vaccine Eligibility Screening Form

In order to distribute the COVID-19 vaccine in an efficient manner, we are pre-screening for eligibility to help to expedite the scheduling of appointments. Please note, this is a screening form that prequalifies you for upcoming vaccination clinics. This form will NOT register you for vaccination. It will only let us know if you are eligible.

Once we know the availability of the vaccine, we will send you a link to register for a clinic day and time to the email that is provided.