Request for COVID-19 Treatment

Are you currently symptomatic? :
Vaccination Status (select one):



High Risk Criteria (check all that apply):

Do you have Liver Disease?:
In the event of a medical emergency call please 911. Requests are processed Monday through Friday and referrals for treatment. Due to the limited supply available, referrals are prioritized to specific high-risk groups designated by the State of Maine. Referrals submitted will be reviewed for eligibility, randomized, and doses will then be allocated to eligible patients as supply allows