Coronavirus Vaccination Notification List
We are keeping a list of patients that have requested to be vaccinated at our facility when the vaccines are available. We do not have any specifics at the time being but will reach out to you when it is available for administration. If you wish to be notified, please sign up below. Must be 16 or above to register.
* Required
Email address
*
Your email
Name (Last name, First name)
*
Your answer
Date of Birth - (required for AI generated rollout date)
MM
/
DD
/
YYYY
Location of Residence (City, Ward) - (required for AI generated rollout date)
Your answer
Please specify if you are in any of these categories.
Medical healthcare worker
Age 65 years and above
Chronic Conditions (Diseases of the Heart, Lung, Liver, Kidney, Blood, Immune system or Diabetes.)
Send me a copy of my responses.
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