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Quinte Health Care
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COVID-19 VACCINE CLINIC - INVITATION ONLY

 

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 register for the COVID-19 Vaccination Clinic at Quinte Health Care Belleville General Hospital (by invitation only).

Complete all required fields in the form. This form must be completed separately for each person requiring a COVID-19 vaccination appointment.  Within 24-48 hours you will be provided with instructions and directions for attending the clinic.  

Quinte Health Care has made an exception to allow the use of unencrypted email for the purpose of registering for vaccination during the pandemic.  In order for QHC to use unencrypted email, we must obtain the consent of the patient for this purpose.    

Do you consent, understanding that unencrypted email carries an inherent risk of disclosure to third parties, to the use of email for the purpose of sending confirmation of your Registration Status for your COVID-19 Vaccination Clinic visit?*
Note: Please enter your name as it appears on your health card.
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