Home Visit Vaccine Sign Up
Indigenous people 12+, their close contacts and household members can sign up to receive COVID-19 vaccines at home or a location of your choice.  A midwife from SGMT will come to you to administer the vaccine.
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El. paštas *
Which dose number is this for?
Išvalyti pasirinkimą
First and Last name (including middle name) *
How long has it been since your last dose? (months)
Are there any health concerns we should make note of?
Date of Birth - Month / Day / Year *
YYYY
-
MM
-
DD
Health Card Number (if you have it)
Address *
Phone
What is your preferred way of communicating?
Kitas
Valyti formą
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