yourcovidshot.com
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45.88.201.114
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Submitted URL: https://yourcovid19shot.com/
Effective URL: https://yourcovidshot.com/
Submission: On December 07 via api from JP — Scanned from JP
Effective URL: https://yourcovidshot.com/
Submission: On December 07 via api from JP — Scanned from JP
Form analysis 10 forms found in the DOM
Name: email-form-2 —
<form id="email-form-2" name="email-form-2" data-name="Email Form 2"><select id="State-4" name="State-4" data-name="State 4" required="" class="form__input state w-select">
<option value="Another Choice">Select State</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
<a href="#" class="submit-button w-button">Validate</a>
</form>Name: email-form —
<form id="email-form" name="email-form" data-name="Email Form">
<div class="div-block-191">
<div class="div-block-256">
<div class="div-block-257"><label for="name" class="field-label">Your Name</label></div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" id="name-11">
</div>
<div class="div-block-256">
<div class="div-block-257">
<div class="field-label">Question/Feedback:</div>
</div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" id="name-11">
</div>
<div class="div-block-256">
<div class="div-block-257">
<div class="field-label">How should we contact you back?</div>
</div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" id="name-11">
</div>
<div class="div-block-9">
<div class="text-block-2-copy smaller">I do not wish to be contacted back, I just wanted to give you my feedback.<br>Email/Call/Text</div>
</div>
<div class="div-block-256">
<div class="div-block-257">
<div class="field-label">If email:</div>
</div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" placeholder="Email" id="name-11">
</div>
<div class="div-block-256">
<div class="div-block-257">
<div class="field-label">If by call:</div>
</div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" placeholder="Phone Number" id="name-11">
</div>
<div class="div-block-256">
<div class="div-block-257">
<div class="field-label">If by text:</div>
</div><input type="text" class="text-field-2 w-input" maxlength="256" name="name-11" data-name="Name 11" placeholder="Cell Phone" id="name-11">
</div>
<div class="div-block-260"><input type="submit" value="Submit" data-wait="Please wait..." class="button-2 v2 w-button"></div>
</div>
</form>Name: email-form-8 —
<form id="email-form-8" name="email-form-8" data-name="Email Form 8" class="form">
<div class="div-block-398"><label for="name-12" class="field-label">FIRST NAME*</label><input type="text" class="text-field-2 w-input" maxlength="256" name="name-6" data-name="Name 6" id="name-6"></div>
<div class="div-block-398"><label for="name-12" class="field-label">LAST NAME*</label><input type="text" class="text-field-2 w-input" maxlength="256" name="name-6" data-name="Name 6" id="name-6"></div>
<div class="div-block-398"><label for="name-12" class="field-label">EMAIL ADDRESS*</label><input type="text" class="text-field-2 w-input" maxlength="256" name="name-6" data-name="Name 6" id="name-6"></div>
<div class="div-block-398"><label for="name-12" class="field-label">PHONE NUMBER*</label><input type="text" class="text-field-2 w-input" maxlength="256" name="name-6" data-name="Name 6" id="name-6"></div>
<div class="div-block-398 hide"><label for="name-12" class="field-label">PROVIDER TYPE*</label>
<div class="w-embed w-script">
<div id="drop-down" name="drop-down">
<label for="provider" id="og-label">What kind of Healthcare Provider are you? </label>
<select name="provider" id="provider" onchange="showHide()">
<option value="0" selected="">Select One</option>
<option value="0">Acute care hospitals</option>
<option value="0">Ambulatory surgical centers</option>
<option value="0">Assisted Living Facilities</option>
<option value="0">Behavioral health providers (e.g., substance use disorder, counseling, psychiatric services)</option>
<option value="0">Dental services</option>
<option value="0">Diagnostic services (e.g., independent imaging, radiology, labs)</option>
<option value="0">DME / suppliers (Durable Medical Equipment)</option>
<option value="0">Eye and vision services</option>
<option value="0">Home and community-based support (e.g., housing services, care navigators, case management)</option>
<option value="0">Home health agencies</option>
<option value="0">Inpatient behavioral facilities (e.g., inpatient rehabilitation facilities, long-term acute care hospitals, other residential facilities)</option>
<option value="0">Multi-specialty practices</option>
<option value="0">Nursing homes and skilled nursing facilities</option>
<option value="0">Other ancillary services (e.g., chiropractors, speech and language pathologists, physical therapy, occupational therapy)</option>
<option value="0">Other inpatient facilities</option>
<option value="0">Other outpatient clinics (e.g., urgent care, dialysis center)</option>
<option value="0">Other services (e.g., foster care, developmental disability services)</option>
<option value="0">Other single-specialty practices</option>
<option value="0">Pediatrics practices</option>
<option value="0">Pharmacies </option>
<option value="0">Primary care practices</option>
<option value="1">OTHER</option>
</select>
</div>
<div name="hidden-panel" id="hidden-panel">
<div class="other-field">
<label for="other" id="other-label">Please specify here </label>
<input type="text" name="country" id="other">
</div>
</div>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.2.1/jquery.min.js"> </script>
<script>
$(document).ready(function() {
$("#provider").change(function() {
if ($("#provider").val() == 1) {
$("#hidden-panel").show()
} else {
$("#hidden-panel").hide()
}
})
});
</script>
</div>
</div>
<div class="div-block-398"><label for="name-12" class="field-label">HOW CAN WE HELP?*</label>
<div class="div-block-274"><textarea name="field-3" maxlength="5000" id="field-3" class="text-field-2 w-input"></textarea></div>
</div>
<div class="div-block-190"><input type="submit" value="Send" data-wait="Send" class="btn-style1-5 w-button"></div>
</form>Name: wf-form-eligibility-state — POST
<form id="eligibility-state" name="wf-form-eligibility-state" data-name="eligibility-state" method="post" class="eligibility-state vertical">
<div class="div-block-370 no-margin">
<div class="form-row-div"><label for="State-7">State</label><select id="State-7" name="State-7" data-name="State 7" required="" class="form__input state w-select">
<option value="Another Choice">Select here</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select></div>
<div class="eligibility-state-trigger"></div><input type="submit" value="Continue" data-wait="Please wait..." class="submit-button-2 _w-sttretch w-button">
</div>
</form>Name: email-form-10 — /patient-information
<form id="email-form-10" name="email-form-10" data-name="Email Form 10" action="/patient-information">
<div class="div-block-370 no-margin _2nd-step">
<div class="form-row-div"><label for="datepicker-2">Birthday</label><input type="text" name="datepicker2" data-name="datepicker2" maxlength="256" required="" class="text-field w-input"></div>
<div class="form-row-div"><label for="Existing-Medical-Condition">Any existing medical conditions</label><select id="Existing-Medical-Condition-2" name="Existing-Medical-Condition-2" data-name="Existing Medical Condition 2" required=""
class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Asthma-with hospitalization">Asthma-with hospitalization</option>
<option value="COPD">COPD</option>
<option value="Cancer">Cancer</option>
<option value="Cerebral Palsy">Cerebral Palsy</option>
<option value="Cystic Fibrosis">Cystic Fibrosis</option>
<option value="Diabetes">Diabetes</option>
<option value="Down Syndrome">Down Syndrome</option>
<option value="Epilepsy">Epilepsy</option>
<option value="HIV">HIV</option>
<option value="Heart Condition">Heart Condition</option>
<option value="Intellectual and Developmental Disabilities">Intellectual and Developmental Disabilities</option>
<option value="Kidney Disease">Kidney Disease</option>
<option value="Metabolic Disorders">Metabolic Disorders</option>
<option value="Muscular Dystrophy">Muscular Dystrophy</option>
<option value="Obesity">Obesity</option>
<option value="Orgran transplant">Orgran transplant</option>
<option value="Pregnancy">Pregnancy</option>
<option value="Severe Genetic Disorders">Severe Genetic Disorders</option>
<option value="Sicle Cell Anemia">Sicle Cell Anemia</option>
<option value="Smoking">Smoking</option>
<option value="Spina Bifida">Spina Bifida</option>
<option value="Weakened Immune System">Weakened Immune System</option>
<option value="None of the Above">None of the Above</option>
</select></div>
<div class="form-row-div"><label for="Occupation-3">Occupation</label><select id="Occupation-2" name="Occupation-2" data-name="Occupation 2" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Childcare Workers">Childcare Workers</option>
<option value="Correctional Officers">Correctional Officers</option>
<option value="Emergency Medical Services (EMS)">Emergency Medical Services (EMS)</option>
<option value="Essential Worker">Essential Worker</option>
<option value="First Responder">First Responder</option>
<option value="Food and Agricultural Workers">Food and Agricultural Workers</option>
<option value="Grocery Workers">Grocery Workers</option>
<option value="Health Care Worker">Health Care Worker</option>
<option value="K-12 Educator">K-12 Educator</option>
<option value="Law Enforcement">Law Enforcement</option>
<option value="Long Term Care Facility Staff">Long Term Care Facility Staff</option>
<option value="Pharmacy Staff">Pharmacy Staff</option>
<option value="Public Health Employee">Public Health Employee</option>
<option value="Public Safety Workers">Public Safety Workers</option>
<option value="Public Transit Workers">Public Transit Workers</option>
<option value="None of the Above">None of the Above</option>
</select></div>
<div class="form-row-div"><label for="Live-in-congregate-facility-3" class="field-label-2">Do you live in a congregate facility like a nursing home, assisted living, or group home?</label><select id="Live-in-congregate-facility-2"
name="Live-in-congregate-facility-2" data-name="Live In Congregate Facility 2" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select></div><input type="submit" value="Submit my eligibility intake form" data-wait="Please wait..." class="submit-button-2 _w-sttretch w-button">
</div>
</form>Name: wf-form-eligibility-state — POST https://formspree.io/f/xnqokqkk
<form id="eligibility-state" name="wf-form-eligibility-state" data-name="eligibility-state" method="post" action="https://formspree.io/f/xnqokqkk" class="eligibility-state vertical">
<div class="first-state">
<div class="div-block-370 no-margin">
<div class="form-row-div"><label for="State-8">State</label><select id="State-7" name="State-7" data-name="State 7" required="" class="form__input state w-select">
<option value="Another Choice">Select here</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select></div>
<a href="#" class="submit-button-2 _w-sttretch w-button">Continue</a>
</div>
</div>
<div class="second-state">
<div class="div-block-370 no-margin _2nd-step">
<div class="form-row-div"><label for="datepicker-3">Birthday</label><input type="text" class="text-field w-input hasDatepicker" maxlength="256" name="datepicker2" data-name="datepicker2" id="datepicker2" required=""></div>
<div class="form-row-div"><label for="Existing-Medical-Condition-3">Any existing medical conditions</label><select id="Existing-Medical-Condition-2" name="Existing-Medical-Condition-2" data-name="Existing Medical Condition 2" required=""
class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Asthma-with hospitalization">Asthma-with hospitalization</option>
<option value="COPD">COPD</option>
<option value="Cancer">Cancer</option>
<option value="Cerebral Palsy">Cerebral Palsy</option>
<option value="Cystic Fibrosis">Cystic Fibrosis</option>
<option value="Diabetes">Diabetes</option>
<option value="Down Syndrome">Down Syndrome</option>
<option value="Epilepsy">Epilepsy</option>
<option value="HIV">HIV</option>
<option value="Heart Condition">Heart Condition</option>
<option value="Intellectual and Developmental Disabilities">Intellectual and Developmental Disabilities</option>
<option value="Kidney Disease">Kidney Disease</option>
<option value="Metabolic Disorders">Metabolic Disorders</option>
<option value="Muscular Dystrophy">Muscular Dystrophy</option>
<option value="Obesity">Obesity</option>
<option value="Orgran transplant">Orgran transplant</option>
<option value="Pregnancy">Pregnancy</option>
<option value="Severe Genetic Disorders">Severe Genetic Disorders</option>
<option value="Sicle Cell Anemia">Sicle Cell Anemia</option>
<option value="Smoking">Smoking</option>
<option value="Spina Bifida">Spina Bifida</option>
<option value="Weakened Immune System">Weakened Immune System</option>
<option value="None of the Above">None of the Above</option>
</select></div>
<div class="form-row-div"><label for="Occupation-3">Occupation</label><select id="Occupation-2" name="Occupation-2" data-name="Occupation 2" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Childcare Workers">Childcare Workers</option>
<option value="Correctional Officers">Correctional Officers</option>
<option value="Emergency Medical Services (EMS)">Emergency Medical Services (EMS)</option>
<option value="Essential Worker">Essential Worker</option>
<option value="First Responder">First Responder</option>
<option value="Food and Agricultural Workers">Food and Agricultural Workers</option>
<option value="Grocery Workers">Grocery Workers</option>
<option value="Health Care Worker">Health Care Worker</option>
<option value="K-12 Educator">K-12 Educator</option>
<option value="Law Enforcement">Law Enforcement</option>
<option value="Long Term Care Facility Staff">Long Term Care Facility Staff</option>
<option value="Pharmacy Staff">Pharmacy Staff</option>
<option value="Public Health Employee">Public Health Employee</option>
<option value="Public Safety Workers">Public Safety Workers</option>
<option value="Public Transit Workers">Public Transit Workers</option>
<option value="None of the Above">None of the Above</option>
</select></div>
<div class="form-row-div"><label for="Live-in-congregate-facility-3" class="field-label-2">Do you live in a congregate facility like a nursing home, assisted living, or group home?</label><select id="Live-in-congregate-facility-2"
name="Live-in-congregate-facility-2" data-name="Live In Congregate Facility 2" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select></div><input type="submit" value="Submit my eligibility intake form" data-wait="Please wait..." class="submit-button-2 _w-sttretch w-button">
</div>
</div>
</form>Name: wf-form-check-state-form —
<form id="check-state-form" name="wf-form-check-state-form" data-name="check-state-form" class="check-state-form vertical">
<div class="form-row-div"><label for="check-state-select">State</label><select id="check-state-select" name="check-state-select" data-name="Check State Select" required="" class="form__input state w-select">
<option value="Another Choice">Select here</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select>
<div class="check-state-trigger"></div><input type="submit" value="Continue" data-wait="Please wait..." class="submit-button-wide-2 w-button">
</div>
</form>Name: wf-form-check-step2 —
<form id="check-step2" name="wf-form-check-step2" data-name="check-step2" class="check-step2">
<div class="eligibility-v2 no-margin _2nd-step">
<div class="form-row-div"><label for="name-14">Birthday</label><input type="text" name="Date" data-name="Date" maxlength="256" required="" class="text-field w-input"></div>
<div class="form-row-div"><label for="email-4">Any existing medical conditions</label><select id="State-4" name="State-4" data-name="State 4" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
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<option value="Cystic Fibrosis">Cystic Fibrosis</option>
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<option value="Metabolic Disorders">Metabolic Disorders</option>
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<option value="Obesity">Obesity</option>
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<option value="Smoking">Smoking</option>
<option value="Spina Bifida">Spina Bifida</option>
<option value="Weakened Immune System">Weakened Immune System</option>
<option value="None of the Above">None of the Above</option>
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<div class="form-row-div"><label for="email-4">Occupation</label><select id="State-4" name="State-4" data-name="State 4" required="" class="form__input state w-select">
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<option value="Grocery Workers">Grocery Workers</option>
<option value="Health Care Worker">Health Care Worker</option>
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<option value="Law Enforcement">Law Enforcement</option>
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<option value="Pharmacy Staff">Pharmacy Staff</option>
<option value="Public Health Employee">Public Health Employee</option>
<option value="Public Safety Workers">Public Safety Workers</option>
<option value="Public Transit Workers">Public Transit Workers</option>
<option value="None of the Above">None of the Above</option>
</select></div>
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<option value="Select here">Select here</option>
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agree to receive text and/or email notifications from yourcovidshot.com. I also understand that available appointments are sometimes booked within seconds of appearing. I will continue to receive notifications for available appointments
until I opt-out. I can reply ‘STOP’ by text or ‘unsubscribe’ via email to be removed from yourcovidshot.com notifications at any time.</span></label></div><input type="submit" value="Confirm my eligibility" data-wait="Please wait..."
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<option value="Another Choice">Select here</option>
<option value="Alabama">Alabama</option>
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<option value="California">California</option>
<option value="Colorado">Colorado</option>
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<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
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<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
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<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
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<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
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<option value="North Dakota">North Dakota</option>
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<option value="Oklahoma">Oklahoma</option>
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<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
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<a href="#" class="submit-button-wide-2 w-button">Continue</a>
</div>
<div class="eligibility-v2 no-margin _2nd-step">
<div class="form-row-div"><label for="name-13">Birthday</label><input type="text" class="text-field w-input hasDatepicker" maxlength="256" name="Date" data-name="Date" id="datepicker" required=""></div>
<div class="form-row-div"><label for="email-3">Any existing medical conditions</label><select id="State-4" name="State-4" data-name="State 4" required="" class="form__input state w-select">
<option value="Select here">Select here</option>
<option value="Asthma-with hospitalization">Asthma-with hospitalization</option>
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<option value="Select here">Select here</option>
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<a href="#" class="submit-button-wide-2 w-button">Submit my eligibility intake form</a>
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<div class="form-row-div"><label for="email-3">Name</label><input type="text" class="text-field w-input" maxlength="256" name="Name-12" data-name="Name 12" id="Name-12" required=""></div>
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<div class="form-row-div"><label for="Cell-Phone-Number-3">Cell Phone Number</label><input type="text" class="text-field w-input" maxlength="256" name="Cell-Phone-Number-2" data-name="Cell Phone Number 2" id="Cell-Phone-Number-2" required="">
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<div class="div-block-452"><label class="w-checkbox checkbox-field-2"><input type="checkbox" id="checkbox-2" name="checkbox-2" data-name="Checkbox 2" required="" class="w-checkbox-input checkbox"><span class="checkbox-label-4 w-form-label">I
agree to receive text and/or email notifications from yourcovidshot.com. I also understand that available appointments are sometimes booked within seconds of appearing. I will continue to receive notifications for available appointments
until I opt-out. I can reply ‘STOP’ by text or ‘unsubscribe’ via email to be removed from yourcovidshot.com notifications at any time.</span></label></div><input type="submit" value="Confirm my eligibility" data-wait="Please wait..."
class="submit-button-2 _w-sttretch w-button">
</div>
</div>
</form>Text Content
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Book COVID shot
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HAVE YOU BOOKED YOUR COVID VACCINE YET?
IF YOU,
TRIED ...
Had NO LUCK ...
Throwing hands in the air?
IF ANY OF THE ABOVE INDICATES TO YOU ... WE MAY BE ABLE TO HELP ... CLICK THE
BUTTON BOOK COVID SHOT
RESOURCES AND DATA FOR YOUR STATE
Book your own appointment
BOOK MY APPOINTMENT FOR ME
Book COVID shot
Who are we? Why are we doing this for others? Who funds your organization?
Are there scammers?
HAVE YOU BOOKED YOUR COVID VACCINE YET?
RESOURCES AND DATA FOR YOUR STATE
Book YOUR own appointment
IF YOU,
TRIED ...
Had NO LUCK ...
Throwing your hands in the air?
IF ANY OF THE ABOVE INDICATES TO YOU ... WE MAY BE ABLE TO HELP ... CLICK THE
BUTTON BOOK COVID SHOT
BOOK MY APPOINTMENT FOR ME
Book COVID shot
Who are we? Why are we doing this for others? Who funds your organization?
Are there scammers?
COVID-19 VACCINES ARE NOW AVAILABLE FOR SELECT GROUPS.
See if you are eligible
We help find and book your covid vaccine appointment. Our service is designed
for those who have not had luck doing that on their own.
We are a team of technologists and administrators that have banded together with
a single mission:
“Streamline the process of finding and booking Covid vaccinations for
individuals, and speed up the process of bringing our lives back to normal.” We
believe finding and booking your vaccine should not have to be a full-time job.
If you are having a hard time booking your Covid vaccine appointment, we may be
able to help.
Many people say that our process is very simple and easy to use. Here are the
steps:
1. Check to see if you may be eligible for a Covid Vaccine in your area.
2. If you are eligible to get your vaccine, we will take your information, and
our staff relentlessly helps to find an available appointment for you, as
close to your residence, and as soon as possible.
3. Once we find an appointment, we book it for you.
4. We will notify you once your appointment is booked and share the specifics
of your appointment, including the name of the authorized healthcare
provider for your vaccine as well as their address and time and date of your
appointment, with you.
YourCovidShot.com is a service to help find available covid vaccination
appointments in your area and assist you in booking your appointment.
If you have other questions - please review our FAQ (“Frequently Asked
Questions”) section below
Find me a provider that has available appointments, and book my vaccine
appointment for me.
OUR STORY ✍️ IN THE MEDIA 📰 & 📺
LOCAL12
Featured by reporter Kathryn Robinson of WKRC on the local12 news in Cincinnati,
Ohio.
Read and watch the full story here.
FOX 4
Featured by reporter Sean McDowell of Fox4 news in Kansas City, MO.
Read and watch the full story here.
ABC 17
Featured by reporter Meghan Drakas of ABC 17 news in Columbia, Missouri.
Read and watch the full story here.
FOX 61
Featured by reporter Matt Caron of Fox61 news in Hartford, Connecticut.
Read and watch the full story here.
BEAUTIFUL WORDS 🙏 FROM AMAZING PEOPLE 🥰 WHOM OUR HEROES 💪 HELPED BOOK THEIR
APPOINTMENTS 🗓️
" I would like to thank you for scheduling my Covid vaccine so quickly. I have
been trying to get the vaccine since I became eligible on February 8 and you
responded in one day! I will be there with a smile on under my mask."
Karla from Cincinnati, OH
" We were so happy to learn of this new website that finds Covid-19 vaccine
appointments for you. My husband and I direct a food pantry and wanted to remain
healthy in order to keep this ministry operating. We have been trying to find a
vaccine ever since his age group was eligible. They were able to get my husband
an appointment the next day and are planning to help me when my age group is
eligible. They were efficient and very kind too. I understand that the founder
of this website lost a family member to Covid-19. You can tell that she has a
true heart to help people stay healthy."
Sherri from Cincinnati, OH
" Thanks Mary and your Volunteers. I so appreciate your hard work. In less than
2 days you had an appointment for me. Unfortunately it was in KY and Gov Andy
ruled no more Ohioans coming over the bridge on that same day we discovered.
Two days later you have another appointment here in Ohio for me.
I have spent countless hours trying to find a time on my own. Zap. You have
found me 2 in just a couple days!
You all are the best. With my poor health a speedy vaccine is going to be
awesome.
Stay safe and healthy. Keep those masks on. God bless."
Debbie from Cincinnati, OH
We were also featured by reporter Kathryn Robinson of WKRC on the local12 news
in Cincinnati, Ohio.
You can read and watch the full story here.
"I saw a story on the Fox 61 news about your site , I have to admit I was very
skeptical about a free site finding appointments for people but went ahead and
joined, then forgot all about it. After spending the day again today trying to
find an appointment I gave up and went to check my e-mail wish I had done it
earlier because there was an e-mail sent at 2:38 am saying I had an appointment
this coming Friday. I can't express how happy I am you people are awesome. I had
already recommended your site to a few friends.
Thank you so much"
John from Torrington, OH
" I would like to thank you for scheduling my Covid vaccine so quickly. I have
been trying to get the vaccine since I became eligible on February 8 and you
responded in one day! I will be there with a smile on under my mask."
Karla from Cincinnati, OH
" We were so happy to learn of this new website that finds Covid-19 vaccine
appointments for you. My husband and I direct a food pantry and wanted to remain
healthy in order to keep this ministry operating. We have been trying to find a
vaccine ever since his age group was eligible. They were able to get my husband
an appointment the next day and are planning to help me when my age group is
eligible. They were efficient and very kind too. I understand that the founder
of this website lost a family member to Covid-19. You can tell that she has a
true heart to help people stay healthy."
Sherri from Cincinnati, OH
" Thanks Mary and your Volunteers. I so appreciate your hard work. In less than
2 days you had an appointment for me. Unfortunately it was in KY and Gov Andy
ruled no more Ohioans coming over the bridge on that same day we discovered.
Two days later you have another appointment here in Ohio for me.
I have spent countless hours trying to find a time on my own. Zap. You have
found me 2 in just a couple days!
You all are the best. With my poor health a speedy vaccine is going to be
awesome.
Stay safe and healthy. Keep those masks on. God bless."
Debbie from Cincinnati, OH
" I was able to easily book my mother's covid shot appointment by using this
website. I had her appointment within 24 hours! I had been trying for weeks to
find a location for the vaccine. Mary was especially helpful and even called me
personally to confirm her appointment. Thanks! Thanks! Thanks! "
Mavis from Cincinnati, OH
HOW DO COVID APPOINTMENT BOOKING SERVICES WORK?
We are a group of technologists and administrators that research and compile
data on healthcare providers who are authorized to offer Covid vaccines to the
eligible public.
We DO NOT administer vaccines.
Our service connects eligible people with providers who administer the
vaccination free of charge.
Our processes are designed to help eligible vaccine candidates who may have had
a hard time booking their appointments, find and book an appointment.
Numerous people have shared with us that many of the current booking systems are
disjointed and, the processes in place are hard to navigate.
Our team has been working to learn the peculiarities of those existing disparate
provider systems to create a single, friendly and intuitive interface. On our
website, eligible individuals register and confirm their eligibility. Meanwhile,
our staff will be working in the background to find and secure an appointment
for the vaccine on the eligible person’s behalf.
Below is what our team will be doing to secure your vaccine appointment:
1. First, they research and find a list of authorized healthcare providers who
offer Covid vaccines in your general area.
2. Second, they contact the authorized providers daily and check on their
vaccine availability.
3. To find an appointment for you as quickly as possible we will need to know
your tolerance for driving. Some providers may have appointment
availability, but the drive may be an hour or longer. Knowing how far you
are willing to travel will help our team know which locations to check and
recheck for appointment availability.
4. Finally, based on your preferences, our team will work to assist in booking
your vaccination as soon as possible.
5. Once they are successful in finding and booking you an appointment, they
will notify you with the name and address of the authorized provider.
Our system has been designed to be secure. Members of our team DO NOT have
access to your personal information. All your health information is securely and
automatically submitted to the health care providers online.
Our team members’ job is to find who may have appointments available.
Once our team finds an available spot, our automated system will submit your
information securely thereafter.
After your appointment is booked, there is a chance that your initial
appointment may be canceled by that provider. We have seen this happen before.
In such cases, you will be notified immediately, and we will try to secure
another appointment for you again.
Most vaccines require two doses. Sometimes, depending on a particular provider,
your second vaccination would need to be scheduled along with your first visit.
In such cases, we will book both appointments at the same time, and let you know
the time and date for each one. Many times providers will book you for your
second vaccine only after you are there to receive your first. They give you
your second appointment in person after receiving your first appointment, thus
eliminating the need to schedule your second appointment.
In rare cases, if your provider does not supply you with a 2nd appointment for
your second dose, you will need to confirm with us online (in your private
portal) after you have successfully received your first vaccine. Our team will,
then, work to book you an appointment for your second dose.
WHAT YOU WILL NEED TO DO FOR US TO BOOK YOUR APPOINTMENT.
01
First, find out if you are eligible by filling out this form. You will need to
give us some basic information to find out if your state considers you eligible
for a vaccine. Once we find out that you are eligible, you will move on to the
next step.
02
Next, you will fill out a form online where we gather additional information
such as insurance information, medical information*, your name, address, the
distance you are willing to travel, times you are available for scheduling,
payment information**, etc.
03
Finally, once we locate an appointment for you based on the distance you are
willing to travel and the times you are available for scheduling, we will notify
you of your vaccine appointment time and date, address location of the provider,
and any other information you will need to bring with you to your appointment.
Notes:
*We follow HIPAA guidelines, and your information is kept safe and secure. We
use our technology to pass the information directly to the provider. None of our
team members see this information or have access to it once you put it in. We
need this information in advance because we supply the information directly to
the provider who is administering your vaccine.
**Our service is free. You are not charged for our services.
DISTANCE AND WHEN YOU ARE AVAILABLE WILL AFFECT HOW FAST WE CAN BOOK YOUR
APPOINTMENT. READ MORE BELOW ABOUT HOW?
How your availability and the distance you are willing to travel affects when
you will be booked.
Two factors affect the ability to be booked for a vaccination.
1. Times you are available. We ask you what times of the day you are available.
The more times you select, the greater the chances of booking your
vaccination faster.
2. The distance you are willing to travel. We ask you to select how far you are
willing to travel, in miles, in any given direction. The farther the
distance the greater the chances of booking your vaccination faster. Some
states only allow you to book within your county. If that is the case, then
these criteria will not be a determining factor in your ability to get an
appointment faster.
WHY ARE WE DOING THIS?
The system to find a vaccination appointment at this time is disorganized and
hard to navigate. With hundreds and sometimes thousands of sites to navigate
and phone numbers to call, we consolidate finding a vaccine in one place. We
wanted to make it easier to get a vaccine, and that is exactly what we are
doing!
Our team’s job is to find you and your loved ones available vaccination
appointments, if you are eligible, or as soon as you become eligible.
Once our team finds you an appointment that matches your guidelines, they will
book your appointment for you. Next, they will notify you of the appointment
and any paperwork you may need to bring with you.
It shouldn’t have to be a daytime job to find a vaccine if you are eligible.
Let us help you.
Get me an appointment!
OUR GOAL AND VISION
Many people have expressed that the process of registering for a Covid vaccine
for themselves or their loved ones is fragmented and difficult. The results are
generally being added to a waitlist or to inform them that all available
vaccines are gone and to check back later.
We have heard many people voice their frustration with that whole process, and
they say that the process is extremely confusing. We heard so many say that they
have spent hours, and a few have even said it has taken them days online and on
the phone, and most did not yield any results.
At best, most were waitlisted with no insight as to their upcoming appointment
date or location or informed that all the vaccines were gone.
Being technologists, we thought there should be a better way.
And we decided to jump in and do something about that.
We put a team of experts together.
And we recruited and trained teams of administrators to help.
Our administrators have researched and located every possible healthcare
provider that was authorized to offer Covid vaccines.
They compiled a very large list across all 50 states and Washington DC.
They also gathered information on eligibility from all 50 states and Washington
DC.
What we do is NOT easy. What we do is very time-consuming. Our team members have
become very good at traversing dozens or even hundreds of sites. They search day
by day and hour-by-hour for the current availability of Covid vaccines, across
multiple states and many different healthcare facilities and healthcare
providers.
Our team members have become comfortable navigating, what sometimes seems to be,
the complicated state and county sites. They have oriented themselves on the
processes of how the different providers and eligibility standards in the
different states work to help secure appointments for people that are eligible
and who need them.
Our specialized administrators and geeks save people time by offering a service,
with authorized providers, to schedule Covid vaccine appointments for eligible
people.
We aim to make booking a Covid19 vaccination easier and make that process less
confusing, and LESS annoying.
At the current stage, the appointments are scarce and go away quickly. Sometimes
many appointment attempts are made to secure the appointment before the
appointment can be secured.
We aim to take the worry out of scheduling your Covid19 vaccine.
And if you become one of the few whose appointment is canceled by your provider,
let us know and we will go back to the drawing board and try to secure another
one for you as soon as possible.
HOW MUCH DOES BOOKING MY COVID19 APPOINTMENT COST?
$0
We book your appointment for FREE!
What you can expect from our services:
* We find an available vaccination appointment time within your desired
distance and time frames
* We supply your information to the provider
* We book your appointment with the provider
* We send your appointment details to you which will include the address and
name of the provider and the time and date of your 1st vaccination
* We give you a list of what you need to bring with you to your appointment.
Common items to bring include your government-issued ID which should match
your name on the appointment, your insurance card, proof of eligibility (if
you are getting a vaccine based on an underlying medical condition)
* We send you appointment reminders on your preferred communication channel:
text, email, or phone call
* We re-book if the provider cancels your appointment
You are not charged for these services.
Appointments are booked upon availability on a first come first serve basis and
always based on eligibility. The distance you want to drive will make an impact
on whether or not we can do this or not within your available time frames.
IS THERE A FREE OPTION?
Yes, sign up for our notifications so that you can see when vaccines become
available in your county. You can then go to the sites directly and attempt to
book your appointment directly with the provider.
Many times available appointments are gone within seconds of becoming available.
If you are not able to book your appointment the first time, try again later.
Sign me up for free notifications!
DO YOU KNOW THE TRUTH ABOUT THE VACCINE?
Here are some good resources from trusted sources about the Covid-19 vaccine.
Covid-19 Vaccine Myths and Facts
Ensuring the Safety of Covid-19 Vaccines in the United States
What to expect at your Covid-19 vaccination
HOW CAN I HELP?
We are in this together and with this all said, we want to stop this globally.
Here are some resources if you want to volunteer, donate supplies or plasma, or
help others in other ways.
YOU CAN VOLUNTEER
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YOU CAN DONATE
Time
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Money
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Plasma
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BACK STORY
By now, most of us have stories about how covid19 has impacted our lives. I am
no different. The vaccine became available a little over a week after my
Grandmother tested positive for covid19. She was in a long-term care facility in
Bay Village, OH (a small suburb on the west side of Cleveland). On December 3rd,
2020 she tested positive for covid19.
I remember my Grandma as a force of nature. Every Sunday she would be cooking
delicious food for the entire extended family. While she was cooking up a storm,
I recall her being feisty, always laughing while she drove my Grandfather mad.
Then, arguing with her kids, while doting on us grandkids.
She was 91 when she passed away. When I first heard the news, I was not that
worried. Don’t get me wrong, she had some health issues. She was scarcely
walking, but like I said she was feisty, and mentally still acute. Long-life
runs in the family. Her father, my great grandfather was 104 when he passed
away. Perhaps I was in denial or just plain naive. I just didn’t think it was
her time. On December 16th she was released from the ICU. The Doctors were
laughing because she was flirting with the good-looking male nurse, and she had
made a strong recovery.
But on December 23rd, she was back in the ICU, and this time she didn’t come
out. She died the next day on Christmas Eve. Leaving a hole in our hearts and at
the dinner table.
My Grandmother’s Timeline with covid19
December 3rd - tests positive for covid
December 11th - vaccines become available to the public
December 15th - ICU 1st time
December 18th - recovers
December 23rd - back to the ICU
December 24th - passes away
After my Grandma passed away, I got even more worried about my husband getting
covid. He is a cancer survivor. He had lung cancer and had half his left lung
removed in 2013. He has since been in remission. Like many others, I have had
many a day filled with anxiety and worry about the prospect of those closest to
me contracting Covid and passing away. Given my Grandma’s passing, it seemed
like it was nearer to me now than ever.
When my Grandma died, not only did I grieve her loss, but I frantically worried
about those closest to me. It was a devastating reality that someone like my
Grandma could be conquered by the disease.
So, I put it on my to-do list to get the vaccines for my husband and me as soon
as we became eligible. It took 40 hours of research and pulling resources to
find and secure our appointments. Yes, I got myself one too, as I qualified
under Texas’ eligibility standards. Then the day before the vaccine, and the
5-hour trip to get it, they canceled our appointment for unknown reasons. This
time we knew the ropes though and it only took 4 hours to find our next
appointment which is scheduled for February 15th and March 15th, 2021 (two doses
scheduled back-to-back of the Moderna vaccine).
I then proceeded to schedule my parents' vaccines for them. When I told my Dad
about the good news. He said you should be doing this for other people too. Can
you guys (me and my husband) build something that can help others too?
From the techniques, I have learned, and because my husband’s background is in
technology and telecommunications, we decided we would start a service to help
others get their vaccines by building a cohesive all in one place system
designed to take the hours of research we did and put it to use so everyone can
benefit from it.
This site has been specifically built to find appointments and book them for
those who are eligible as per each state’s standards.
VOLUNTEER WITH US!
Be a part of the solution! Help get eligible people vaccine appointments at
authorized providers.
Covid19 has changed everything, for some more than others. Many older people are
afraid to leave their houses. While others are worried that when they do, they
will fall ill or worse. Help your community by helping in our efforts to book
vaccination appointments.
Apply Now!
MORE INFO - FAQS
DO YOU CHARGE ANYTHING?
+
No, the service is free.
WHY ARE YOU PROVIDING THIS SERVICE?
+
The impacts from the loss of my Grandmother prompted us to do what we can for
others. This is something we have the ability to do, so therefore, it must be
done.
WHAT HAPPENS IF MY APPOINTMENT GETS CANCELED?
+
We schedule you for the next available appointment, and notify you when your new
appointment is scheduled.
HOW DO I CANCEL MY APPOINTMENT?
+
You will get an email directly from your provider where we scheduled your
appointment. You can cancel your appointment there.
WHAT IF I HAVE AN UNDERLYING HEALTH CONDITION THAT IS NOT STATED ON MY STATE’S
ELIGIBILITY STANDARDS?
+
You can always talk to your physician. They can direct you on if you do qualify
for that underlying health condition. We only abide by the state eligibility
standards. Therefore, are only able to provide appointments for those that are
eligible as per the state’s guidelines. Many times if you go to a provider
without proof of eligibility they can cancel your appointment. So, be sure to
follow eligibility standards.
Book an Appointment
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SELECT YOUR STATE TO CHECK YOUR APPOINTMENT AVAILABILITY
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CONTACT US
We're open for any suggestion or just to have a chat
Mary and Ray Bolouri
Call/Text: xxx-xxx-xxxx
Email: hello@americansourcing.com
Fill out the form below and we will get back to you within 24 hours.
Your Name
Question/Feedback:
How should we contact you back?
I do not wish to be contacted back, I just wanted to give you my feedback.
Email/Call/Text
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LET'S GET IN TOUCH
Feel to reach out to us with any questions you may have, or just to have a chat.
COVID Appointment Coordinators
Call/Text: (281) 519-3455
Email: heroes@yourcovidshot.com
FIRST NAME*
LAST NAME*
EMAIL ADDRESS*
PHONE NUMBER*
PROVIDER TYPE*
What kind of Healthcare Provider are you? Select One Acute care hospitals
Ambulatory surgical centers Assisted Living Facilities Behavioral health
providers (e.g., substance use disorder, counseling, psychiatric services)
Dental services Diagnostic services (e.g., independent imaging, radiology, labs)
DME / suppliers (Durable Medical Equipment) Eye and vision services Home and
community-based support (e.g., housing services, care navigators, case
management) Home health agencies Inpatient behavioral facilities (e.g.,
inpatient rehabilitation facilities, long-term acute care hospitals, other
residential facilities) Multi-specialty practices Nursing homes and skilled
nursing facilities Other ancillary services (e.g., chiropractors, speech and
language pathologists, physical therapy, occupational therapy) Other inpatient
facilities Other outpatient clinics (e.g., urgent care, dialysis center) Other
services (e.g., foster care, developmental disability services) Other
single-specialty practices Pediatrics practices Pharmacies Primary care
practices OTHER
Please specify here
HOW CAN WE HELP?*
Thank you! Your submission has been received!
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Find out if you are eligible
Book my appointment
Our Story
Contact Us
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WHO ARE WE?
We are a group of technologists and administrators who have directly or
indirectly been impacted by Covid. We have seen first hand that people are
having a hard time navigating the very complex and confusing paths to book their
appointments for the Covid vaccines.
We decided we can leverage our expertise to help those that may need it by
providing a cohesive system where available appointments can be gathered and
booked for those that are eligible.
WHY ARE YOU DOING THIS?
Most of us have had family members or close friends affected by covid19.
For me, it was when my Grandmother passed away from Covid19 just 2 weeks before
the vaccine became available. If the vaccine would have been available, she
would have still be alive today.
We want to help others who are eligible to get the vaccines and book their
appointments at authorized providers.
WHO FUNDS YOUR ORGANIZATION?
There are some costs to our services such as notifications that go out and the
staff that gets paid to assist you with the process of booking your appointment.
Services for notifications are provided at no cost to us through generous
sponsor companies such as itext.io and other amazing partners who have the same
passion to help.
We are constantly looking for volunteers who want to also help. If you would
like to volunteer, email us volunteer@yourcovidshot.com or
heroes@yourcovidshot.com.
THE SITE IS GOING LIVE BY 7 PM CST!
YourCovidShot.com is a group of individuals and volunteers who are participating
to help book appointments for the underserved and underprivileged, who are
eligible and need the covid19 vaccine.
The use of our site is 100% free, and we don’t ask for anything in return.
Please note, our site is scheduled to go live tonight. Currently, you can
navigate to the grey button that says ‘book YOUR own appointment’ to find state
resources that you may need to book your appointment.
Please stay tuned for further information, and bear with us until we officially
launch late tonight, Wednesday, February 2021.
WE ARE LIVE!
THE FIRST STEP IS TO ENSURE YOU ARE ELIGIBLE.
If you already know you are eligible, click here:
Book my appointment for me
If you are unsure if you are eligible, we can let you know before you proceed.
Currently, our eligibility is a semi-manual process. We need to check updated
guidelines for your state and ensure all criteria are met.
In the next step, you will provide some basic information to help validate your
eligibility. After a review by one of our volunteers, we will notify you by
EMAIL
or
TEXT
or BOTH
Click below to start your eligibility process.
Check my eligibility
ELIGIBILITY INTAKE FORM COMPLETE
We will check your eligibility before we book your appointment. If for some
reason we find you are not eligible in your state, we will notify you. In such
cases we will not book your appointment and will book you automatically once you
do become eligible.
To check for current eligibility requirements for your state, visit
YourCovidShot.com/state-information.
Book My Appointment
STEP 1 - ELIGIBILITY FORM
Make an Appointment at an Authorized Provider Near You. Eligibility intake will
be first.
Fill out the form, and we will confirm your eligibility.
You are eligible, you may continue.
Book My Appointment
State Select here Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Oops! Something went wrong while submitting the form.
Birthday
Any existing medical conditions Select here Asthma-with hospitalization COPD
Cancer Cerebral Palsy Cystic Fibrosis Diabetes Down Syndrome Epilepsy HIV Heart
Condition Intellectual and Developmental Disabilities Kidney Disease Metabolic
Disorders Muscular Dystrophy Obesity Orgran transplant Pregnancy Severe Genetic
Disorders Sicle Cell Anemia Smoking Spina Bifida Weakened Immune System None of
the Above
Occupation Select here Childcare Workers Correctional Officers Emergency Medical
Services (EMS) Essential Worker First Responder Food and Agricultural Workers
Grocery Workers Health Care Worker K-12 Educator Law Enforcement Long Term Care
Facility Staff Pharmacy Staff Public Health Employee Public Safety Workers
Public Transit Workers None of the Above
Do you live in a congregate facility like a nursing home, assisted living, or
group home? Select here Yes No
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
ELIGIBILITY INTAKE FORM COMPLETE
We will check your eligibility before we book your appointment. If for some
reason we find you are not eligible in your state, we will notify you. In such
cases we will not book your appointment and will book you automatically once you
do become eligible.
To check for current eligibility requirements for your state, visit
YourCovidShot.com/state-information.
Book My Appointment
STEP 1 - ELIGIBILITY FORM
Make an Appointment at an Authorized Provider Near You. Eligibility intake will
be first.
Fill out the form, and we will confirm your eligibility.
You are eligible, you may continue.
Book My Appointment
State Select here Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Continue
Birthday
Any existing medical conditions Select here Asthma-with hospitalization COPD
Cancer Cerebral Palsy Cystic Fibrosis Diabetes Down Syndrome Epilepsy HIV Heart
Condition Intellectual and Developmental Disabilities Kidney Disease Metabolic
Disorders Muscular Dystrophy Obesity Orgran transplant Pregnancy Severe Genetic
Disorders Sicle Cell Anemia Smoking Spina Bifida Weakened Immune System None of
the Above
Occupation Select here Childcare Workers Correctional Officers Emergency Medical
Services (EMS) Essential Worker First Responder Food and Agricultural Workers
Grocery Workers Health Care Worker K-12 Educator Law Enforcement Long Term Care
Facility Staff Pharmacy Staff Public Health Employee Public Safety Workers
Public Transit Workers None of the Above
Do you live in a congregate facility like a nursing home, assisted living, or
group home? Select here Yes No
Oops! Something went wrong while submitting the form.
STEP 1 - ELIGIBILITY FORM
Make an Appointment at an Authorized Provider Near You. Eligibility intake will
be first.
Fill out the form to get notified by text/email of covid19 vaccine appointment
availability in your area.
You are eligible, you may continue.
Book My Appointment
State Select here Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming
Oops! Something went wrong while submitting the form.
Birthday
Any existing medical conditions Select here Asthma-with hospitalization COPD
Cancer Cerebral Palsy Cystic Fibrosis Diabetes Down Syndrome Epilepsy HIV Heart
Condition Intellectual and Developmental Disabilities Kidney Disease Metabolic
Disorders Muscular Dystrophy Obesity Orgran transplant Pregnancy Severe Genetic
Disorders Sicle Cell Anemia Smoking Spina Bifida Weakened Immune System None of
the Above
Occupation Select here Childcare Workers Correctional Officers Emergency Medical
Services (EMS) Essential Worker First Responder Food and Agricultural Workers
Grocery Workers Health Care Worker K-12 Educator Law Enforcement Long Term Care
Facility Staff Pharmacy Staff Public Health Employee Public Safety Workers
Public Transit Workers None of the Above
Do you live in a congregate facility like a nursing home, assisted living, or
group home? Select here Yes No
Thank you for submitting the eligibility form. You should expect a response
during our normal business hours (9 am - 5 pm EST), within 2 hours after your
eligibility has been reviewed and validated.
Oops! Something went wrong while submitting the form.
Name
Email
Cell Phone Number
I agree to receive text and/or email notifications from yourcovidshot.com. I
also understand that available appointments are sometimes booked within seconds
of appearing. I will continue to receive notifications for available
appointments until I opt-out. I can reply ‘STOP’ by text or ‘unsubscribe’ via
email to be removed from yourcovidshot.com notifications at any time.
Thank you for submitting the eligibility form. You should expect a response
during our normal business hours (9 am - 5 pm EST), within 2 hours after your
eligibility has been reviewed and validated.
Oops! Something went wrong while submitting the form.
STEP 1 - ELIGIBILITY FORM
Make an Appointment at an Authorized Provider Near You. Eligibility intake will
be first.
Fill out the form to get notified by text/email of covid19 vaccine appointment
availability in your area.
You are eligible, you may continue.
Book My Appointment
State Select here Alabama Alaska Arizona Arkansas California Colorado
Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi
Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York
North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South
Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West
Virginia Wisconsin Wyoming Continue
Birthday
Any existing medical conditions Select here Asthma-with hospitalization COPD
Cancer Cerebral Palsy Cystic Fibrosis Diabetes Down Syndrome Epilepsy HIV Heart
Condition Intellectual and Developmental Disabilities Kidney Disease Metabolic
Disorders Muscular Dystrophy Obesity Orgran transplant Pregnancy Severe Genetic
Disorders Sicle Cell Anemia Smoking Spina Bifida Weakened Immune System None of
the Above
Occupation Select here Childcare Workers Correctional Officers Emergency Medical
Services (EMS) Essential Worker First Responder Food and Agricultural Workers
Grocery Workers Health Care Worker K-12 Educator Law Enforcement Long Term Care
Facility Staff Pharmacy Staff Public Health Employee Public Safety Workers
Public Transit Workers None of the Above
Do you live in a congregate facility like a nursing home, assisted living, or
group home? Select here Yes No
Submit my eligibility intake form
Name
Email
Cell Phone Number
I agree to receive text and/or email notifications from yourcovidshot.com. I
also understand that available appointments are sometimes booked within seconds
of appearing. I will continue to receive notifications for available
appointments until I opt-out. I can reply ‘STOP’ by text or ‘unsubscribe’ via
email to be removed from yourcovidshot.com notifications at any time.
Oops! Something went wrong while submitting the form.