Pre-Consultation Covid 19 Autumn 2023 Booster Vaccination Form

Unfortunately you may not be eligible to book using this service at this time as it has not yet been 6 months since your last vaccination.

Please ring the pharmacy on 01-7006080 if it is at least 3 months since your last vaccine and believe it is necessary for your protection. Please ask to speak to a pharmacist.

At this stage you do not need a booster dose since you had a Covid-19 infection within the last 4 months. Please wait at least 4 months since your last PCR or antigen positive test before applying for another booster dose.

Thank you for answering the questions thus far. At this stage you are still eligible for an Autumn booster vaccine.

The next part of this form contains requests for personal and medical details from you. These details are necessary at this stage to save us all time when you are getting your vaccine at the pharmacy. Please complete this form in its entirety where possible. If you are unsure about an element you may skip ahead.