JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
SinoPharm Registration Form
Please fill in your details accurately as it will assist us in providing you with a smooth registration process.
WL&H has received approval under the SAR to provide Sinopharm COVID-19 vaccines in Singapore.
Please submit a separate form for each person you wish to reserve the vaccine.
After submission, we will contact you for the arrangement of your appointment booking.
The WL&H Medical Centre is located in Shaw Centre #20-11/13.
*Please note that in the event that you decide not to take the vaccination after consulting our doctor, there will be a consultation fee.*
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Full name
*
Your answer
Mobile Number
*
Your answer
Email
*
Your answer
Are you registering for your first, second or third (booster) dose of Sinopharm Vaccine?
*
First dose
Second dose
Third dose
Fourth dose
Required
Have you had any history of anaphylaxis to any component of the vaccine? (*Known ingredients: Inactivated virus, Disodium hydrogen phosphate-2, sodium chloride, sodium dihydrogen phosphate, aluminium hydroxide adjuvant and water.)
*
Yes
No
Other:
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms