COVID-19 vaccination registration form for general practice

Staged distribution of COVID-19 vaccines for Phase 1a of the national rollout strategy in our region is being coordinated through centralised hospital hubs managed by Western Health, Monash Health and Austin Health.

Some people working in general practice in our region are eligible to be vaccinated in Phase 1a. This group includes general practice staff who are visiting residential aged care and disability care settings.

Western Health has asked us to collect data for the general practice workforce in our region who are eligible to be vaccinated in Phase 1a. This will allow Western Health to contact each individual at the appropriate time to schedule their COVID-19 vaccination at a hospital hub.

Western Health will send out invitations by email. It is critical that you look out for your invitation and respond promptly.

Who should complete this form?

The form needs to be completed once for each staff member who is eligible to be vaccinated in Phase 1a of the national rollout strategy. This means people visiting aged care and/or disability care settings as part of their work in general practice. Click the link below to access the form.

Access the form


Who should not complete this form?

The Australian Department of Health has advised that general practices performing COVID-19 testing in their clinic are included in Phase 1b of the rollout strategy. If your practice is performing testing, please do not complete this form (unless you are also visiting aged and/or disability care facilities).

We expect vaccinations for people in Phase 1b to begin soon. We will confirm the timing as soon as we can and will continue to advocate for general practices to receive the vaccinations as soon as possible.

GP-led respiratory clinics (GPRCs) funded by the Australian Government do not need to complete this form.

Health care workers who are not currently working in general practice do not need to complete this form.

Bulk uploads

If you need to submit data for more than 10 people and would like to request a bulk upload option, please contact