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Pharmacy: The Pharmacy on Petrie

Address: EG01A Canberra Center
Bunda St
CANBERRA, ACT, 2601

Phone: 02 6249 8074

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Appointment duration: min

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Hepatitis A

Duration: 15 min

Hepatitis B

Duration: 15 min

HPV

Duration: 15 min

Measles, Mumps and Rubella (MMR)

Duration: 15 min

Meningococcal (ACWY only)

Duration: 15 min

Polio

Duration: 15 min

Shingles (50+)

Shingles

Duration: 15 min

Typhoid

Duration: 15 min

Whooping Cough (Diptheria + Tetanus)

Duration: 15 min

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First Name*

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Dose

Medicare Number

IRN

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Name on card

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I am consenting as a substitute decision-maker (e.g. carer) on behalf of the patient

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Consent to pilot clinical service and costs*

I agree to participate in the pilot and understand the scope of the clinical service. I consent to paying the pilot consultation fee and any costs associated with the service. I understand that if I decide not to proceed with receiving some part of a service, I may still be required to pay for services that have already been provided.

Consent to pilot evaluation*

I consent to participating in the evaluation of the pilot and agree to being contacted to participate in surveys about the pilot. I consent to my administrative health service data being analysed for evaluation purposes.

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This program closes at 4pm AEST July 31st. Do not book a vaccination after this date/time.

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