Pfizer Vaccine Pre Registration Form
If you are aged 40-59 or aged 16-39 classifying under a 1A or 1B category, please register your interest in the Pfizer vaccine by filling in the form below.

When the immunisation is available for you in accordance to the phase rollout, we will be in contact to book you in for your Pfizer vaccine.
Email *
First Name *
Last Name *
Phone number *
Date of Birth *
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DD
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YYYY
In what phase are you eligible to have your vaccine? *
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