DPH Form Available to Request Vaccines for Homebound Individuals

If you or someone you care for is physically or medically unable to leave their home to get the COVID-19 vaccine, please fill out this online homebound vaccination intake form: https://dphsubmissions.ct.gov/homebound. This form includes the criteria for homebound eligibility.

Once submitted online, the intake forms are sent to each town on a weekly basis. With this weekly schedule, it means that a call back from the town contact person may take a week or two and a scheduled appointment could be an additional two to three weeks or more. Each town is setting up or has already set up the homebound vaccination process.