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Registration form for COVID Vaccination
1) Kindly Provide Accurate Details ( As Per CNIC)
2) Do not come for the vaccination until you get confirmation email from our official email address i.e. (
parklanehospital01@gmail.com
)
3) Time and date punctuality is mandatory
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Age (Must be in Years)
*
Your answer
Gender
*
Male
Female
Mobile Number
*
Your answer
CNIC Number
*
Your answer
Complete Address (As Per CNIC)
*
Your answer
District of the residence
*
East
West
South
North
Client Type
*
Health Care Worker
General Public
Which Dose?
*
First
Second
Required
Please Enter the code that you have received from 1166
Your answer
Are you currently suffering from any of below diseases?
*
Diabetes
Cardiac Issues
Kidney
Blood Pressure
Any Other
None of the above
Existing Vaccination Centre
Your answer
Send me a copy of my responses.
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