APPLICATION TO REGISTER FOR COVID-19 VACCINATION

This form is intended for non-residents who do not have an Estonian personal identification code.

All citizens and residents of the Republic of Estonia, who have a personal identification code and the possibility to use the Patient Portal www.digilugu.ee, should book their vaccination on that site using the National eBooking system. The people who have a personal identification code, cannot use this form to apply for a vaccination.

In the National eBooking system, people can book vaccination appointments at their preferred vaccination center. Patients of Perekliinik can also book their vaccination appointments elsewhere if that is more convenient for them.

FIRST AND LAST NAME*
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.*
Choose a health care facility*
Just Creative