Vaccination Questionnaire
Please tick the answers below, sign and submit.
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9. I am under 18 years old. *

Please make you vaccinator aware of this at the appointment.

10. I am severely immunosuppressed *

Please make you vaccinator aware of this at the appointment.

11. Are you on anticoagulants? *

Please make you vaccinator aware of this at the appointment.

12. Are you pregnant *

Please make you vaccinator aware of this at the appointment.

If you are under 18 and recently had COVID, you need to wait 12 weeks from the date you tested positive before being vaccinated.