Please note: this webform works best using an updated browser other than Internet Explorer, such as Google Chrome or Microsoft Edge.
This webform is for use to pre-register for the COVID-19 Vaccination Clinic at Quinte Health Care Belleville General Hospital.
Complete all required fields in the form. This form must be completed separately for each person requiring a COVID-19 vaccination appointment. Within 24 hours you will be provided with instructions and directions for attending the clinic.
Your second dose of COVID-19 vaccine will also be booked for you when you submit this form (scheduled for 35 to 42 days after your first dose).
Quinte Health Care has made an exception to allow the use of unencrypted email for the purpose of preregistering during the declared emergency. In order for QHC to use unencrypted email, we must obtain the consent of the patient for this purpose.