Commonwealth’s Self Attestation Form

All residents must demonstrate their eligibility to receive the vaccine. Eligibility can be established by self- attestation.

Most pharmacies such as CVS Health, require individuals to attest to their eligibility as part of the online appointment scheduling process.

All other sites will accept the Commonwealth’s Self Attestation form, which can be filled out online.  https://www.mass.gov/forms/covid-19-massachusetts-vaccination-attestation-form

Residents should be prepared to present this form in a hard copy or electronically at their appointment.

All residents should bring one of the following forms of identification to your appointment:

• Employer-issued ID card that includes your name and title; or

• Government-issued identification or license; or
• Recent paystub.