As a provider of health/social care or care support services (contracted, non-contracted or self-employed) we need some details from you in order to contact you and book you in for vaccination.
Please note that our focus is very much on vaccinating frontline staff (including both clinical and operational staff who are in direct contact with patients through clinical/and administrative duties), therefore, you should only complete this if you, or your staff (if you are completing it on their behalf) are regarded as frontline. We appreciate a number of staff will be performing their duties as non-contact facing role from home, and we would ask for your/their patience, as staff in such roles will be called with the rest of the population in due course.
If applicable please complete this form for processing. For organisations who employ a number of staff who would prefer to send us details in a single list, please contact firstname.lastname@example.org for a group template.
Your details will only be stored and used for the purpose of vaccination, and will then be destroyed.