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COVID-19 Vaccination Record Query Form
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COVID-19 Vaccination Record Query Form
COVID-19 Vaccination Record Query Form
Please enter your details carefully. Questions marked with a red asterisk (
*
) must be completed.
First name
*
*
Last name
*
*
Email
*
*
*
*
Confirm email address
*
*
*
Describe your query
*
*
Phone number
*
*
*
Street address
*
*
Address line 2
*
City/Suburb
*
*
Postcode
*
*
State
*
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Date of birth
*
*
NSW Health staff
*
NSW Health staff
No
NSW Health staff
Yes
Stafflink ID
*
Do you have a Medicare number?
*
Do you have a Medicare number?
No
Do you have a Medicare number?
Yes
Medicare Card Number
*
Medicare IRN
*
*
Medicare Card Expiry
*
Name as it appears on Medicare Online
*
Please enter your Individual Healthcare Identifier number (IHI)
*
If you do not have an IHI from Services Australia, please visit the
Services Australia website
Is your query regarding your first dose, second dose or both?
*
First Dose
Second Dose
Both
Is your first dose showing in your record?
Is your first dose showing in your record?
No
Is your first dose showing in your record?
Yes
First dose LHD
Central Coast Local Health District
Far West Local Health District
Northern Sydney Local Health District
Northern NSW Local Health District
Where did you receive your first COVID-19 vaccination dose?
Broken Hill Mobile Clinic
Broken Hill Vaccination Clinic
Buronga Vaccination Clinic
Dareton Library
Namatjira Reserve
Wentworth Showgrounds
Wentworth Vaccination Clinic
Ballina District Hospital
Bonalbo Vaccination Clinic
Bay Pop-Up Clinic
Byron Central Hospital
Casino & District Memorial Hospital
Grafton Vaccination Clinic
Lismore Vaccination Clinic
Maclean District Hospital
Murwillumbah District Hospital
Tweed Heads Vaccination Clinic
Bungee Bidgel Vaccination Clinic
Hornsby Hospital Vaccination Hub
Mona Vale Hospital Vaccination Hub
Northern Sydney Big Red Vaccination Bus
Royal North Shore Hospital Vaccination Hub
Central Coast Mobile Vaccination Clinic
Central Coast Nunyara Vaccination Clinic
Gosford Hospital Vaccination Clinic
Wyong Hospital Vaccination Clinic
Balranald Vaccination Clinic
What date did you receive your first COVID-19 dose?
*
Is your second dose showing in your record?
Is your second dose showing in your record?
No
Is your second dose showing in your record?
Yes
Second dose LHD
Central Coast Local Health District
Far West Local Health District
Northern Sydney Local Health District
Northern NSW Local Health District
Where did you receive your second COVID-19 vaccination dose?
Broken Hill Mobile Clinic
Broken Hill Vaccination Clinic
Buronga Vaccination Clinic
Dareton Library
Namatjira Reserve
Wentworth Showgrounds
Wentworth Vaccination Clinic
Ballina District Hospital
Bonalbo Vaccination Clinic
Bay Pop-Up Clinic
Byron Central Hospital
Casino & District Memorial Hospital
Grafton Vaccination Clinic
Lismore Vaccination Clinic
Maclean District Hospital
Murwillumbah District Hospital
Tweed Heads Vaccination Clinic
Bungee Bidgel Vaccination Clinic
Hornsby Hospital Vaccination Hub
Mona Vale Hospital Vaccination Hub
Northern Sydney Big Red Vaccination Bus
Royal North Shore Hospital Vaccination Hub
Central Coast Mobile Vaccination Clinic
Central Coast Nunyara Vaccination Clinic
Gosford Hospital Vaccination Clinic
Wyong Hospital Vaccination Clinic
Balranald Vaccination Clinic
What date did you receive your second COVID-19 dose?
*
Do you require the record for travel, work, or medical reasons?
*
Do you require the record for travel, work, or medical reasons?
No
Do you require the record for travel, work, or medical reasons?
Yes
