This form will provide the University of Maryland Health System with the information needed to determine your vaccination prioritization using guidance from the Maryland Department of Health's COVID-19 Vaccination Plan.

Completing the form DOES NOT create an appointment. Once it is your turn and an appointment is available, you will receive an email or phone call with further information about how to schedule an appointment. Due to a high volume of requests, wait times between submitting a request form and receiving an invitation to schedule could be significant.

If you are unable to complete this form online, please ask a healthcare provider, friend, neighbor, or family member for assistance.

BEFORE YOU GET THE VACCINE, you MUST talk to your doctor as needed for guidance related to individual medical conditions (e.g., history of allergic reaction, bleeding disorders, immunocompromised individuals, etc.). If you have a history of severe allergic reaction to another vaccine or injectable therapy, you WILL NOT be able to get the COVID-19 vaccine unless you have gotten approval from your doctor PRIOR TO your appointment.

Please do NOT resubmit this form with a duplicate request as this will cause confusion for the scheduling team and will result in further delays.

There is a limited supply of vaccine nationwide. Please be patient as we work to provide our patients with an opportunity to make a vaccine appointment.


There are some issues with your request
The birthdate you entered indicates that you are 75 years old or older. Is that accurate?
The birthdate you entered indicates that your age is between 65 and 74. Is that accurate?
The birthdate you entered indicates that your age is between 60 and 65. Is that accurate?
The birthdate you entered indicates that your age is between 55 and 59. Is that accurate?
The birthdate you entered indicates that you are . Is that accurate?
Accuracy of this selection is important as only the Pfizer brand is approved for ages 12-17 at this time.
You must be at least 12 years old to receive the currently approved COVID-19 vaccines.
If you are under the age of 12, do not proceed with submitting this form. Visit https://www.umms.org/VaccineCompare to learn more about the age requirements for both vaccines.
Please retype the email address again to ensure it is valid.
Please retype the email address again to ensure it is valid.

You will see a series of questions that will help identify your eligibility to receive the vaccine. Once you respond to a question that pertains to you, you will be able to submit the registration. If none of the questions pertain to you, you will be placed in phase 3.

If you are over 75 you are eligible in the 1A category. You will not have to respond to any questions.

If you fall into multiple categories, select one as your primary selection.
If you fall into multiple categories, select one as your primary selection.
If you fall into multiple categories, select one as your primary selection.
If you fall into multiple categories, select one as your primary selection.
If you fall into multiple categories, select one as your primary selection.
If you fall into multiple categories, select one as your primary selection.
If you are a Maryland resident age 12 and older please submit your registration.
There are some issues with your request