• Request a Covid-19 Vaccine

  • Complete this form to register for a Covid-19 Vaccine when it is available to the public. Then the medical centre you choose from our network will contact you to schedule an appointment when the vaccine is available.
    Our website explains the Ministry of Health staged roll-out plan. Please check your eligibility criteria and which group you're in before completing the form. You can use this tool to find out when you can get vaccinated

    Please understand, if you do not meet the current vaccination criteria you will have to wait until your group in the roll-out.

  • Clinic Selection

  • Your Details

  • Important

    Before submitting this form please ensure you read the Consumer Medicine Information Summary relating to the Covid-19 Vaccine here. Please also double check your eligibility and which group you are in.