Coronavirus
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Register to be Vaccinated
Register for vaccination
Thank you for your commitment to having the COVID-19 vaccine–it will provide added protection against the virus for you, your family and the community.
Please complete the form below to Register your Interest. Those fields with a red asterisk
*
are mandatory to complete.
For the Cohort field please select from the drop down list the one that best aligns with the questions you answered yes to in the Eligibility Checker.
We will be in contact with you (via email) when appointments become available. Availability of appointments can be delayed by vaccine supply, the number of other citizens wanting to be vaccinated and/or the timing of vaccine clinics set up in your geographical area.
If you are unsure what to enter in the fields or are having difficulties entering an email address please call 134 COVID (13 42 68).
We look forward to seeing you soon at one of our COVID-19 vaccine clinics.
General
Contact Details
First Name
Last Name
Email
Phone number
Gender
Male
Female
Unspecified
Postal Code
Date of Birth (dd/mm/yyyy)
Medicare Number (inc Reference No)
Aboriginal and/or Torres Strait Islander Origin
Aboriginal but not Torres Strait Islander origin
Torres Strait Islander but not Aboriginal origin
Both Aboriginal and Torres Strait Islander origin
Neither Aboriginal nor Torres Strait Islander origin
Origin not stated/unknown
--
Registration Code
Cohort
Aboriginal and Torres Strait Islander people
Adult aged 60 years and over
Adult aged under 60 years
Any other eligible criteria not identified e.g. Household contact
Designated critical workers including defence, police, fire, emergency services and meat processing
Disability worker
Frontline health care worker
Other healthcare workers, including carers and support volunteers
Persons 16 and over with an underlying medical condition, including people with a disability
Quarantine and Border workers
Residential Aged Care worker
Suburb
Do you have an underlying medical condition ?
Do you have an underlying medical condition ?
No
Do you have an underlying medical condition ?
Yes
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