Request your 2nd COVID Vaccination

Park Royal Medical Practice Vaccination Centre

To complete this form you need your NHS number. Your NHS number is a 10 digit number, like 485 777 3456. It is on any letter you receive from the NHS. If you do not know your NHS number please go to the NHS website to easily find your NHS number.

You must come with photo ID. Please do not attend earlier than your booking time.

Request your 2nd COVID Vaccination

Enquire about your second COVID Vaccination
Format day/month/year e.g. 12/05/1979
A 10 digit number, you dont know your NHS number, go to https://www.nhs.uk/nhs-services/online-services/find-nhs-number/
Your COVID vaccine invitation will be sent to this number
Are you Clinically Extremely Vulnerable (with a Shielding letter)? *
Do you have your shielding letter? *
Did you have your first vaccination at a different vaccination centre? *

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with one of our member practices, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS.

The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. When you submit your information, it is safely transmitted over the web in an encrypted form. If you are not completely happy to provide information via the internet please contact your practice directly.

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