1. Patient Information
3.Please indicate if you or the person to be vaccinated
4. Relevant only for receiving AstraZeneca COVID-19 Vaccine
5. Relevant only for those receiving Pfizer or Moderna COVID-19 Vaccine
If you answered Yes to any of the above questions, you may still be able to receive Pfizer or Moderna,
however you should talk to your GP, immunisation specialist or cardiologist first to discuss the best timing
of vaccination and whether any additional precautions are needed.
Please read information sheet on AstraZeneca to help with your decision
Please read the facts relating to weighing up the potential benefits of the vaccine.
please read information on thrombosis with thrombocytopenia
please read on potential side effects after taking your vaccination
Consent to receive immunisation