COVID-19 first vaccination request

Use this service to request your first COVID-19 vaccination.

You can use this service if you:

  • are registered at the surgery

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
Start now

You can also phone us on Albion House 01384 465422 or Withymoor Surgery 01384 465422.