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Covid-19 Vaccination Contact Form – 75yr and Over

Date: 04/02/2021

We are currently working as quickly as we can to vaccinate as many people is the shortest possible time.

As you can imagine, this can be difficult if patients contact details are not up to date. We have recently been finding that some patients 75 years old or over have either out of date contact details or just not returning our calls.

If you are aware of a patient that is waiting for a Covid-19 vaccination who is 75 years or over, has not have covid-19 in the last 28 days and does not have an appointment already, please fill out the contact form below and the surgery will get in contact with you or the patient directly.

COVID-19 vaccination Contact Form
Is the patient 70 year of age or older?
We are currently working on age group below the age of 70 years and kindly request your patience. Most patients are being contacted via text message (if mobile phone numbers are available). If you wish to supply your correct mobile phone number, please click here. However, if you do not have a mobile number or do not wish to be contact by mobile, we will call you in the usual way.

Patient’s Details

Please use format day/month/year e.g. 12/05/1979
Are we to contact the patient direct *

Contact Patient Direct

Contact via Relation

Does the patient consent to us contacting you regarding the appointment? *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.