JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Visitor COVID-19 Vaccination Record訪客新冠疫苗紀錄
Kindly provide us with your vaccination record so that we can save time in checking your vaccine status for your visits. 請探訪者/家人填寫疫苗接種紀錄，讓探訪更為順暢。
Sign in to Google
to save your progress.
Learn more
* Indicates required question
My First Name 我的名字:
*
Your answer
My Last Name 我的姓氏:
*
Your answer
My email 我的電郵
Your answer
My phone number 我的電話
*
Your answer
My loved one's name 長者的名字:
*
Your answer
Resident’s Room Number 長者的房間號碼:
*
Your answer
Have you received two doses of a World Health Organization approved COVID-19 vaccine? 您是否已經接種兩劑由世界衛生組織認可的新冠疫苗？
*
Yes 我已經完成接種
No yet 我尚未完成接種
Date of your second dosage 您接種第二劑疫苗的日期:
MM
/
DD
/
YYYY
Please select your proof of vaccination 請選擇您現持有的疫苗證明:
*
I have downloaded my Vaccine QR Code 我已經下載電子疫苗卡。
I have a paper record from the vaccine clinic. 我有由疫苗診所發給我的針紙。
I have a COVID-19 immunization record wallet card 我有接種疫苗紀錄卡。
Others 其他證明
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
