COVID-19 Vaccination Waitlist

Please note: this form is to request an appointment for a COVID-19 vaccination. It does not guarantee an appointment or a vaccination. We have requested doses from the State of Maine, however, we do not know when (or if) we will receive additional doses. We recommend that you get the vaccination as soon as you are able to do so, wherever that may be.

We are allowing anyone to request a vaccination appointment at this time, but will administer vaccine based on eligibility phases as outlined by the Maine State CDC. The below form will collect the information we will need to make sure that you qualify for a vaccination based on the state’s current qualifications. It’s important to understand that the qualifications set forth by the state change frequently and without notice. Some of the information collected may not be relevant now, but could be in the future.

Because of overwhelming responses, we ask that you please do not contact us directly relating to your sign up or the vaccination. Once we receive doses, we will contact you.

For more general information about the COVID-19 vaccine, including vaccination rates in Maine, click here.
For more information on whether or not you qualify, you can visit the State of Maine’s FAQ website here.

Definitions from the form above:

Who is considered a Maine State resident?

A Maine resident is defined as an individual living in the State of Maine with the intent to remain indefinitely, or has entered the State with a job commitment or seeking a job. Proof of residency includes but is not limited to a Maine-issued driver’s license or state identification card; a bill or other piece of mail that includes the person’s name and Maine address; or, in the case of individuals entering the state for a job, a letter or statement from their employer verifying their employment in Maine.

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