Sign up for SMS vaccination reminders
We send free reminders from birth to 5 years of age to ensure your child receives all vaccinations provided for free by the government. Reminders are sent 7 days and 1 day before the date of each scheduled vaccination. Reminders are available in a variety of languages. Please do not complete this form if your child is older than 5 years old.
Child's first name
Please enter your child's first name only, do not enter your family name.
Your answer
Child's Date of Birth *
Please enter the date your child was born
MM
/
DD
/
YYYY
Mother's First Name *
Please enter the child's mother's first name only, do not enter your family name.
Your answer
Phone number to receive SMS *
Do not include the country code +91.
Your answer
Preferred Language *
How many times after birth have you taken your child in to get a round of vaccinations?
Do not include the round they received at birth. Example: if you have taken your child in two times after the time they were vaccinated at birth please fill in two
No times other than birth
Five or more
How old is your child? *
Please indicate if your child is under 1 year's of age or over 1 year's of age
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service