Covid Vaccine Booking Form (Eng/Chi)

Covid Vaccine Booking 新冠疫苗预约

Level 8, 175 Queen Street, Auckland 1010 Ph09 2222577 Form last updated 7th Mar 23 Email:info@caringclinic.co.nz
您来过本诊所吗？ Have you been to our clinic before ? *

有 Yes, I have been没有，现在填写资料 No, fill in your details below我在新西兰没看过病 (可能需要帮您申请健康号）I've never seen a doctor in New Zealand (we may need to apply NHI for you)我也想注册家庭医生（因为我符合注册条件；您填完这表格后会转到注册表） I would also like to enrol as I'm Eligible (you will be redirected after you submitted this form)
姓名 Full Legal Name ：*

Title称呼 First Name 名 Last Name 姓
手机号 Mobile ：*
phone number
出生日期 Date of Birth:*

DayMonthYear
NHI (national health index) if known/ 国家健康号（如果知道）：
if your enrolled clinic is not caring clinic, please get your NHI from your enrolled GP 若有自己家医，请让家医提供给您你的健康号）
Please select which shot you are having（请选您打的是第几针）：refer https://covid19.govt.nz if unsure indication*

1st Covid (Pfizer) vaccine（第一针）2nd Covid (Pfizer) vaccine (min 21 days after 1st) (第二针,最少21天后）1st Booster (第三针，最少在第二针的三个月后）2nd Booster (available from 1st April 23) (第四针，最少在第三针的六个月后）

end of casual Form details
Appointment*
If you have a previously booked time/date ，or family/partner wanting to do at same time, please let us know below （若之前约过别的时间,或有其他家人想约在一起，请写下让我们更改）:
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Covid Vaccine Booking 新冠疫苗预约