RNPC MT

Appointment for vaccination

City*

Healthcare organization*

Approximate date*

Passport data in Latin letters:

Name *

Surname*

Passport Number or another document for travelling abroad*

Date of birth*

Sex*

Male

Female

Citizenship*

Phone number*

Email: (please, wait for mail appointment confirmation)*:

Appointment confirmation*

Note. The application can be sent only if you agree with all the points:

*Here by, I confirm my consent to collecting and processing of my personal data.

*Here by, I confirm the accuracy of my personal data and I personally be responsible for their correctness.

*Vaccination (vaccination-1 and vaccination-2) can be carried out in the absence of contraindications, in the absence of an acute disease or exacerbation of a chronic disease at the time of vaccination. Before the appointment of vaccination, the doctor may prescribe additional laboratory tests (their cost is not included in the cost of the vaccination course).

*You may experience some post-vaccination reactions after getting vaccinated. Within 30 minutes after the vaccination, medical supervision will be organized in the Healthcare organization.

*I undertake to comply with the requirements of the legislation of the Republic of Belarus upon arrival in the territory of the Republic of Belarus.

*I am notified that in accordance with the legislation of the Republic of Belarus, I may be refused of entry to the Republic of Belarus.