SWSLHD - COVID-19 Vaccination record query

First Name:

Last Name:

Address:

Suburb:

Post Code:

Phone Number:

Email:

Confirm Email Address:

Date of Birth:

Do you have a Medicare Number?:

Yes No

Medicare Card Number:

Individual Reference Number:

Medicare Card Expiry Date:

Is your first dose showing in your record?:

Yes No N/A

Where did you receive your first dose?:

What date did you get your first COVID-19 vaccination dose?:

Is your second dose showing in your record?:

Yes No N/A

Where did you receive your second dose?:

What date did you get your second COVID-19 vaccination dose?:

Do you require the record for travel, work, or medical reasons?:

Yes No

Additional Information/comments:

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