1. Patient Information
2. Next of Kin (in case of emergency)
3. Pre-Vaccination Screening
4. Relevant only for those 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 information on Vaxzevria (AstraZeneca) vaccine and thrombosis with thrombocytopenia:
Please read what to do after you are vaccinated for COVID-19, including how to get your vaccination certificate, what you need to do to stay safe and what to do if you have side effects:
If you are a patient’s guardian or substitute decision-maker.