This form is optional and is only for Requesting enrollment with the Vaccine Administration Management System (VAMS). The CT Department of Public Health will identify which phase you meet for vaccine rollout. Once you meet the current phase, then you will receive an email from VAMS to complete your registration and schedule an appointment for COVID-19 vaccination.
You do not need to register with VAMS if you have other options for getting the vaccine.
Please complete this form to request enrollment in the Vaccination Administration Management System (VAMS). You will need to enter your full name, date of birth, eligible occupation or Age eligibility, Zip Code and email address. The information you enter will only be used for purposes of scheduling your vaccination, and will be kept private.
Once you meet the current phase, then you will receive an email from VAMS to complete your registration and schedule an appointment for COVID-19 vaccinatio
At this time, ONLY people eligible under Phase 1a or Phase 1b who are age 65 and over may register here. Please only fill out this form if you are eligible to receive the vaccine.