FREE Covid and Booster Vaccinations Request for ANYONE
WE ARE OPEN FOR COVID VACCINATIONS ON THURSDAYS ONLY 9AM  TO 5PM.

 If you are an enrolled patient, you can also ring us to book an appointment on 5702999 or fill out this form after hours.

For anyone else who is not enrolled please complete this form. We will ring you back to arrange an appointment.

You can book your COVID-19 vaccination now if you are eligible.

NOTE: if you have had Covid, you need to defer your vaccination until 3 months after your infection.

PLEASE READ THE INSTRUCTIONS:

1. We will call back to arrange a suitable time. Please let us know if you are coming in with anyone else who is having a Covid vaccine as well.

2.  If you have any symptoms of cough, sore throat, runny nose, loss of smell, fever or shortness of breath, OR have been a close contact on in a location of interest within the last 2 weeks. You will have to defer your vaccine.

3. Please read the Privacy Statement
https://covid19.govt.nz/assets/resources/Vaccine-resources/COVID-19-vaccines_privacy-statement.pdf

4. Please read this information about getting your vaccine.
https://covid19.govt.nz/assets/resources/Vaccine-resources/COVID-19-vaccines-what-to-expect.pdf

For more information on the vaccine please see below:-
https://covid19.govt.nz/covid-19-vaccines/get-the-facts-about-covid-19-vaccination/covid-19-vaccine-resources/covid-19-vaccine-fact-sheets/

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Email *
Please provide preferred date of vaccination. Please only select a Thursday.
We will call you to arrange a time on that date.
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Who are you filling this form out for? *
If other,  it has to be with their consent.
Surname *
First name *
Sex *
Date of birth *
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Mobile phone number *
Are you an enrolled patient of Mt Wellington Family Health Centre? *
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