COVID-19 Vaccination Booking

How it Works

This is the fastest way to secure your COVID-19 Vaccination Booking with your Eastbrooke Clinic.

Complete the form below and submit it to your Eastbrooke clinic.
Our COVID-19 Vaccination team will book your COVID-19 Vaccination Appointment at the earliest time available and contact you with the details.
Please do not call the clinic directly about your vaccination. We will contact you via the phone and email contact details you supply.
New patients will be required to complete our new patient information form and will be required to provide a health summary from their previous GP. Details will be provided before your vaccination appointment.

COVID-19 Vaccinations Form

First Name

Last Name

Phone/Mobile

State

Clinic

Are you an existing patient

Your Date of Birth

Medicare Card Number

Vaccine Preference

Additional Family Members

I would like to add additional Family Members

Additional Family Members you would like to request a vaccination for (Must be on the same Medicare Card)

Full Name	Date of Birth	Number on Medicare Card	Vaccine Preference