You should only complete this form if you have received either one or two COVID-19 vaccinations at a Victorian vaccination centre.
Do not fill this form if you received your COVID-19 vaccine at a doctor's clinic, pharmacy or community health service or interstate provider. Instead, you should contact your vaccination provider directly about the missing or incorrect information.
After you submit your information, you will be contacted within 14 business days.
Reviewed 02 March 2023