Covid Vaccination Appointments for Howick Health and Medical Centre
You can book your appointment in 3 ways: 1. fill in this form, 2. email us your Full name/DOB/address/NHI no, or call. We will ring or email you back to arrange an appointment. Please do tell us if you are unable to come to your appt (call preferably during the weekday, text or email back) to avoid vaccine wastage.


PLEASE READ THE INSTRUCTIONS CAREFULLY:

1. Please let us know if you are coming in with anyone else who is having a COVID vaccine as well.

2. If you have any symptoms of cough, sore throat, runny nose, loss of smell, fever or shortness of breath, OR have been a close contact within the last 2 weeks you will have to defer your vaccine.

3. Please note which car park you are in when arriving.

4. Please read the Privacy Statement
https://covid19.govt.nz/assets/resources/Vaccine-resources/COVID-19-vaccines_privacy-statement.pdf

5. Please read this information about getting your vaccine.
https://covid19.govt.nz/assets/resources/Vaccine-resources/COVID-19-vaccines-what-to-expect.pdf



For more information on the vaccine please see below:-
https://covid19.govt.nz/covid-19-vaccines/get-the-facts-about-covid-19-vaccination/covid-19-vaccine-resources/covid-19-vaccine-fact-sheets/
Email *
Please provide preferred date of vaccination. *
We will email or call you to arrange a time on that date.
Who are you filling this form out for? *
If other, it has to be with their consent.
Surname *
First name *
Sex *
Date of birth *
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/
DD
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YYYY
Mobile phone number *
Are you an enrolled patient Howick Health and Medical Centre? *
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