During Phase Two of the BC COVID-19 vaccination plan specific categories of community-based healthcare providers providing direct patient care in acute and community health care settings (including home care) will have the opportunity to be vaccinated between now and early April. Those providing direct patient/client care only in community social services settings are not eligible for vaccination currently. Only the occupations listed in the survey are eligible.

This form is to identify eligible health care providers who have not been booked for an appointment and are interested in receiving a COVID-19 vaccination. If the above description does not include your current role, please do not fill in the form at this time.

Please note:

Your participation is voluntary and by completing this form, you are consenting to Island Health collecting and using your information for the purposes described below. Island Health will take all reasonable steps to ensure that your personal information is treated confidentially, and is kept secure as required by FIPPA.

The data collected will only be used for scheduling purposes in booking vaccination appointments.

Please complete the form only once, and ensure all fields are entered exactly as they appear on your Government issued identification (e.g. BC Services Card or Drivers License). Please note, if you received your first COVID 19 vaccine dose from an Island Health immunization clinic, Island Health will contact you for your second dose appointment and there is no need to complete this survey.

All appointments will be scheduled by order of the Provincial Priority list and are based on vaccine availability.

*Please ensure that you have read the medical considerations for vaccination prior to submitting your information*

Thank you!

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