APPLICATION FOR COVID-19 VACCINATION REGISTRATION

Vaccination is only available with prior registration. Please fill in the form and we will contact you to arrange a time for vaccination.

Vaccinations are done in the Ülemiste Perekliinik, address Valukoja 7/2, 1st

FIRST AND LAST NAME*
PERSONAL IDENTIFICATION CODE OR DATE OF BIRTH*
*If you do not have a personal identification code, please enter your date of birth.
AGE*
SEX*
DOCUMENT NUMBER*
NATIONALITY*
PHONE NUMBER*
E-MAIL ADDRESS*
CHRONIC DISEASES*
IMPORTANT INFORMATION ABOUT HEALTH*
HAVE YOU PREVIOUSLY HAD ANY ALLERGIC REACTIONS TO VACCINATIONS?*
INFORMATION ABOUT ALLERGIC REACTION*
Please list any prescription or over-the-counter medicines you are currently taking:*
ADDITIONAL INFORMATION
Have you given a positive test?*
Please add the date of your positive test result.*
Just Creative