Vaccine Registration
To facilitate an appointment, you are requested to fill up this form which will help us to register and call you back for your choice of appointment.

The vaccination is voluntary. As per the selection criteria of the HJ Hospitals (authorised by PEV), we shall provide the vaccination against covid-19 to any individual, provided "that he/she is over 18 years of age and that the vaccination team finds no contraindication to the Covishield Vaccine”.

Consultation with the doctor is compulsory before the vaccination to avoid any complications. HJ Hospitals shall provide a vaccination certificate to every individual after taking the dose.

For more inquires, you can call at our services client: +243815586555
Full name (First, Middle and Last) *
Gender *
Date of Birth *
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Nationality *
Passport Number *
Mobile number *
Location *
Preferred date for vaccination
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