COVID Vaccination Appointment Cards and Proof of Vaccination Fliers request (for COVID vaccinating clinics only)

Introduction, please read closely.

General Practices that are delivering COVID-19 vaccinations in the SEMPHN region can request COVID vaccination Appointment cards and Proof of Vaccination fliers using this survey.

The stock is supplied by the Commonwealth and is limited.

South Eastern Melbourne PHN will allocate according to the number of vaccines your practice is currently allocated.

South Eastern Melbourne PHN can only supply to practices within our catchment. If needed please check the PHN Locator online.

Question Title

* 1. General Practice name

Question Title

* 2. Address Street and number. Line 1 (max 30 characters)

Question Title

* 3. Address Street and number. line 2 (max 30 characters)

Question Title

* 4. Address Suburb

Question Title

* 5. Address Postcode

Question Title

* 6. Select your LGA (council area)

Question Title

* 7. Requesting Name

Question Title

* 8. Phone number

Question Title

* 9. Email

Question Title

* 10. Position

Question Title

* 11. Please select if you want both or just the cards or fliers

BOTH Cards and Fliers

Appointment Cards ONLY

Get proof of your COVID-19 vaccination Fliers ONLY

Question Title

* 12. What is your current (maximum) weekly allocation of COVID-19 vaccines?

100

150

200

400

Thank you for your request. SEMPHN will seek to respond by email within 3 weekdays.
Generally delivery will occur on Mondays and Fridays.