COVID19 Vaccination Checklist

Please complete the form below and then click SEND.
If you do not have a GMS number please enter your PPN number in the box provided. 





1. Have you had Anaphylaxis (serious allergic reaction requiring medical intervention) following a previous dose of the vaccine or any of it’s constituents?


If yes you are not eligible for the vaccination at this time.

2. Have you been diagnosed with Covid-19 within the last four weeks


If yes, you will not be eligible for vaccination until four weeks after your Covid-19 diagnosis.

3. Have you had another vaccine within the last 14 days?


If yes, you will not be eligible until vaccine 14 days after your last vaccination.

4. Do you have a bleeding disorder or are you on anticoagulation therapy?


No action on either yes or no, knowledge transfer to vaccinator.

5. Are you less than 14 weeks or more than 33 weeks pregnant?


If yes, you are not eligible for vaccination at this time.
If no, but you are more than 14 weeks and less than 33 weeks pregnant and consenting to vaccination, before vaccination happens please discuss the risks and benefits of receiving the vaccine with your obstetric care provider and confirm with them that you are at the correct stage of pregnancy to receive the vaccine.