Special Needs Vaccine Pre-Registration

Tuesday, March 9, 2021 -
Wednesday, March 9, 2022


Autism New Jersey is proud to partner with the Visiting Nurse Association of Central Jersey to accommodate individuals with autism and I/DD with special needs in getting the vaccine.

Completing this form is the first step in getting your vaccination appointment, but is not a guarantee of an appointment.

Upon completion of the form, you will be added our list and notified if and when an appointment becomes available for a special needs accommodation spot at VNACJ’s clinic in Holmdel, New Jersey.  (Note:  You may only be given 24 hours notice should a slot become available.)

To fill out this form, patient must: be 18-years of age or older, have autism or I/DD, be in a current priority group, and have special needs that would prevent them from obtaining the vaccination from a public site.

Health Services
Intellectual and Developmental Needs

Last Updated: 03/16/21