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COVID-19 Vaccine Registration Form - Amref Medical Centre


  • The Amref Medical Centre has personnel trained in the issuance of the vaccination against COVID-19. We currently receive our vaccine from the Ministry of Health, the vaccine is therefore provided at no cost.

  • If you would like us to contact you, when the vaccine becomes available at our facility, please complete the form below and you will be registered on our database.

  • When the Amref Medical Centre is issued vaccine doses, you will receive an email indicating the appointment date and time for your COVID-19 Vaccine.

  • By completing this booking form, you are in agreement to the booking instructions on the registration form and Terms and Conditions

  • Note: Fields Marked with (*) are Compulsory

Please select Adult or Child (Under 18)

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Details of Person Receiving the Vaccine


Note: Enter the Full Names of Person as they appear on Official Documents like National ID OR Passport

Please enter as they appear on your National ID or Passport

Full Names exactly as they appear on your National ID or Passport

Select Identification Type

Enter ID or Passport Number

Invalid email address. Please Enter only 1 email address. No spaces after email address!

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Please enter phone number eg. 0722909090. No spaces, no dashes (-)

SMS notifications will be sent to this number

/ / Select Date of Birth

Vaccines are for 18 and above only

Please select country

Select Gender

Invalid Input

Emergency Contact


Please type Full Name of Emergency Contact

Enter Phone Number

Select Relationship with Next of Kin


Invalid Input