COVID-19 Vaccination Record

Name*
First Last
Email*
How many doses of the COVID-19 vaccine have you had?*
- 0
- 1
- 2
- 3
- 4
Date of first dose*
DD slash MM slash YYYY
Date of second dose*
DD slash MM slash YYYY
Date of third dose*
DD slash MM slash YYYY
Date of fourth dose*
DD slash MM slash YYYY
Do you (or did you) require a third primary dose to complete your full course?*
- Yes
- No
This is different to a booster dose. A 3rd dose of a COVID-19 vaccine is being offered to people aged 12 and over who had a weakened immune system when they had their first 2 doses.
What is the reason for you not having had a complete course?*
Documentation

Please upload a copy of your NHS COVID pass (or EU equivalent).

We ask that you provide us with the "Travel" version of the pass as this is the only version that contains confirmation of your details alongside your vaccination record. For information on how to download the pass, please see here: Getting a digital NHS COVID pass

It must be a PDF. We cannot accept images of your paper vaccination card.
Please upload a copy of your NHS COVID pass or EU equivalent*
Accepted file types: pdf, Max. file size: 1 GB.
Documentation

Please upload a copy of your NHS COVID Medical Exemption Letter

For information on how to receive the letter, please see here: COVID-19 medical exemptions: proving you are unable to get vaccinated
Please upload a copy of your NHS COVID Medical Exemption Letter*
Max. file size: 1 GB.

Documentation