COVID-19 Vaccine Claims Scheme medical report form (MO063)

Use this form as proof if you’re making a claim under the COVID-19 Vaccine Claims Scheme.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

Download and complete the COVID-19 Vaccine Claims Scheme medical report.

A health professional needs to complete this form so you can submit it with your claim. Find out more about the COVID-19 Vaccine Claim Scheme.

Before you complete this form, check if you or the person you’re claiming for are eligible under the scheme and what proof you need.

Page last updated: 12 April 2023.
QC 55977