Eswatini Ministry of Health

Vaccine Registration - COVID-19

Fields marked with an * are required

First Name *

Last Name *

National ID

Birthdate

Gender *

Primary Phone *

Secondary Phone *

Inkhundla *

Do you work in the healthcare sector? *

Which of the following is closest to your position? *

Where do you work? *

Other workplace *

What is the highest level of education completed? *

Place of Residence *

Are you or could you be pregnant? *

Are you planning to become pregnant? *

Are you breastfeeding *

In the past two weeks, have you tested positive for COVID-19? *

Have you ever had severe allergic / anaphylactic reaction to any vaccine? *

Do you have a bleeding disorder or are you on a blood thinner? *

Have you received a COVID-19 vaccine previously? *

Have you had any vaccinations in the past 14 days? *

Preferred SMS Language *