COVID Vaccination Appointment Request

YOU MUST BE OVER 65 TO REQUEST A COVID VACCINATION APPOINTMENT FOR OUR CLINIC BEING HELD ON THE AFTERNOON OF FRIDAY 26TH FEBRUARY - THIS CAN BE COMPLETED YOUR BEHALF IF NEEDED. THE VACCINE PROVIDED WILL BE THE ASTRA ZENECA OXFORD VACCINE.

Last Updated: 22/02/2021

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COVID VACCINE Eligibility Questions

YOU MUST BE OVER 65 YEARS OLD, OR COMPLETING THIS ON BEHALF OF SOMEONE WHO IS 65 YEARS OLD. IF YOU ARE NOT OVER 65 THIS FORM WILL BE DELETED AUTOMATICALLY. IF YOU ARE HOUSEBOUND YOU WILL BE CONTACTED BY THE MASS VACCINATION CLINIC