COVID-19 Vaccination Request

The Detroit Medical Center is committed to providing safe, quality care to the community we serve. Based on the guidelines and regulations provided by the state, DMC is now able to offer COVID-19 vaccinations to people 16 years of age and older.

If eligible, please remember to bring the following to your appointment:

  • A form of identification verifying your date of birth
  • Proof of insurance (if applicable)
  • Proof of your employment as an essential worker

You may request a COVID-19 vaccination by filling out the form below; only one person per form. Once complete, our schedulers will follow up with a phone call if you meet the eligibility requirements at this time.

By submitting this form you agree to receive periodic health-related information and updates. We welcome your comments, questions, and suggestions. We cannot give you medical advice via e - mail. To discuss any medical symptoms or conditions contact your physician or other healthcare professional. In the case of emergency, call 911 or go to the nearest emergency room immediately. Information on this page is secure. We value your privacy.