_________________________________________________________________________________
To schedule an appointment, please fill in the required questionnaire so that we can gather information regarding your readiness for COVID-19 vaccination, and offer guidance and instruction to ensure your safety. You will need to provide the following details:
Demographic details
Such as race, ethnicity, gender, age
Medical history
Current/past ailments and allergy information
COVID-19 history
History of any COVID-19 infections, testing or vaccinations
Contact information
Your contact details
