{"id":2140,"date":"2021-09-09T20:49:10","date_gmt":"2021-09-09T20:49:10","guid":{"rendered":"http:\/\/khoo.com.au\/?page_id=2140"},"modified":"2021-09-19T12:37:49","modified_gmt":"2021-09-19T12:37:49","slug":"pva","status":"publish","type":"page","link":"https:\/\/khoo.com.au\/index.php\/pva\/","title":{"rendered":"Pfizer Vaccine Appointments"},"content":{"rendered":"\n<p><strong>You need to ring the practice on 9829 3033 to get a tentative appointment time before filling this form.<\/strong><\/p>\n\n\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-2136\"><form id=\"wpforms-form-2136\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2136\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2140\" data-token=\"689367a928b366f0fb51bb53ddc5ed44\" data-token-time=\"1776656160\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2136-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-2136-field_16\">Your upcoming Pfizer\/Novavax vaccination<\/label><input type=\"text\" id=\"wpforms-2136-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" placeholder=\"Your upcoming Pfizer Comirnaty vaccination\" ><div class=\"wpforms-field-description\">Medical experts have studied the Pfizer, Novavax vaccines to make sure they are safe. Most side effects are mild. They may start on the day of vaccination and last for around a few days. As with any vaccine or medicine, there may be rare and\/or unknown side effects. The Pfzer vaccine is the preferred Covid-19 vaccine for pregnant women. It is recommended that children between 12-16 years old Comirnaty vaccine.     \r\nTwo injections of the vaccine is required and the recommended interval between the injections is 3 weeks.<\/div><\/div><div id=\"wpforms-2136-field_13-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Check list: If you have any of the conditions listed below, you may still qualify for the Pfizer or Novoavax vaccine but you must discuss your suitability for vaccination with our doctor. Please make a bulk billed appointment with us before the day of your vaccination. Please tick all that applies: <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2136-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_1\" name=\"wpforms[fields][13][]\" value=\"1. I have not had any adverse reaction to previous Pfizer or Novavax vaccine\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_1\">1. I have not had any adverse reaction to previous Pfizer or Novavax vaccine<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_2\" name=\"wpforms[fields][13][]\" value=\"2. I do not have a haematological disease called mastocytosis\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_2\">2. I do not have a haematological disease called mastocytosis<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_3\" name=\"wpforms[fields][13][]\" value=\"3. I do not have a weakened immune system (immunocompromised)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_3\">3. I do not have a weakened immune system (immunocompromised)<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_9\" name=\"wpforms[fields][13][]\" value=\"4. I do not have recent symptoms of being unwell - fever, cough, sore throat, etc \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_9\">4. I do not have recent symptoms of being unwell - fever, cough, sore throat, etc<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_8\" name=\"wpforms[fields][13][]\" value=\"5. I have not received any other vaccinations in the last 7 days\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_8\">5. I have not received any other vaccinations in the last 7 days<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_7\" name=\"wpforms[fields][13][]\" value=\"6. I have not had previous myocarditis, pericarditis, endocarditis, rheumatic fever, \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_7\">6. I have not had previous myocarditis, pericarditis, endocarditis, rheumatic fever,<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_6\" name=\"wpforms[fields][13][]\" value=\"7. I do not have a congenital heart disease\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_6\">7. I do not have a congenital heart disease<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_5\" name=\"wpforms[fields][13][]\" value=\"8. I have not been diagnosed with severe heart failure\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_5\">8. I have not been diagnosed with severe heart failure<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_13_4\" name=\"wpforms[fields][13][]\" value=\"9. I am not a heart transplant recipient\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_13_4\">9. I am not a heart transplant recipient<\/label><\/li><\/ul><\/div><div id=\"wpforms-2136-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Consent:  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2136-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_14_1\" name=\"wpforms[fields][14][]\" value=\"I confirm that none of the conditions above apply, or I have discussed these and\/or any other special circumstances with my regular health care provider and\/or vaccination service provider  I agree to receive at least one dose of Pfizer Comirnaty vaccine. I will inform the doctor if I had an adverse reaction from my first Pfizer vaccination.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_14_1\">I confirm that none of the conditions above apply, or I have discussed these and\/or any other special circumstances with my regular health care provider and\/or vaccination service provider  I agree to receive at least one dose of Pfizer Comirnaty vaccine. I will inform the doctor if I had an adverse reaction from my first Pfizer vaccination.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_14_4\" name=\"wpforms[fields][14][]\" value=\"I agree to remain at the practice for 15 mins after the vaccination to ensure there are no immediate adverse reactions\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_14_4\">I agree to remain at the practice for 15 mins after the vaccination to ensure there are no immediate adverse reactions<\/label><\/li><\/ul><\/div><div id=\"wpforms-2136-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2136-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-2136-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2136-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-2136-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2136-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_17\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required><div class=\"wpforms-field-description\">dd\/mm\/yyyy<\/div><\/div><div id=\"wpforms-2136-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"11\"><label class=\"wpforms-field-label\">Identify as <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2136-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_11_1\" name=\"wpforms[fields][11][]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_11_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_11_2\" name=\"wpforms[fields][11][]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_11_2\">Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_11_3\" name=\"wpforms[fields][11][]\" value=\"Non-binary\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_11_3\">Non-binary<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_11_4\" name=\"wpforms[fields][11][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_11_4\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-2136-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_3\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-2136-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_4\">Suburb <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-2136-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_5\">Post code <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-2136-field_7-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_7\">Mobile Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2136-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-2136-field_9-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_9\">Email (optional)<\/label><input type=\"email\" id=\"wpforms-2136-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" spellcheck=\"false\" ><\/div><div id=\"wpforms-2136-field_6-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_6\">Medicare Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2136-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" required><div class=\"wpforms-field-description\">Please ensure this is correct or your vaccination will not be recorded for your vaccination certificate<\/div><\/div><div id=\"wpforms-2136-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_18\">Medicare Reference No. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-2136-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_19\">Medicare Expiry Date <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2136-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required><div class=\"wpforms-field-description\">mm\/yy<\/div><\/div><div id=\"wpforms-2136-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><label class=\"wpforms-field-label\">This is my  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2136-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_8_1\" name=\"wpforms[fields][8][]\" value=\"First Pfizer Jab\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_8_1\">First Pfizer Jab<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_8_2\" name=\"wpforms[fields][8][]\" value=\"Second Pfizer Jab\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_8_2\">Second Pfizer Jab<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_8_3\" name=\"wpforms[fields][8][]\" value=\"Booster jab (Pfizer) - 16 years and over\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_8_3\">Booster jab (Pfizer) - 16 years and over<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_8_4\" name=\"wpforms[fields][8][]\" value=\"kids (5-12 yo) jab\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_8_4\">kids (5-12 yo) jab<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-2136-field_8_5\" name=\"wpforms[fields][8][]\" value=\"First Novavax - 18 years and older\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2136-field_8_5\">First Novavax - 18 years and older<\/label><\/li><\/ul><\/div><div id=\"wpforms-2136-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_20\">For patients under 18 yo, please enter name of parent providing consent:<\/label><input type=\"text\" id=\"wpforms-2136-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/div><div id=\"wpforms-2136-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2136-field_2\">Comment or Message<\/label><textarea id=\"wpforms-2136-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"2136\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/pages\/2140\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2136\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/khoo.com.au\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n<p>Your appointment is not confirmed till we receive your consent form above. We will email or text you the confirmed appointment time and date. If you do not receive confirmation within 24 hours, please call us on 98293033.<\/p>\n\n\n\n<p>On the day of vaccination, please bring:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Your Medicare Card<\/li><li>A photo ID (unless &lt;16 years old)<\/li><\/ul>\n\n\n\n<p> We expect to run on time or very close to. Please come <strong>no earlier than 10 mins<\/strong> before your appointment.  If you are early, please stay in your car. You are expected to stay for 15 mins after your vaccination.<\/p>\n\n\n\n<p>If you have made an appointment and you don&#8217;t turn up, the vaccine prepared for you will be <strong>wasted and discarded<\/strong>. Let&#8217;s not waste our precious vaccines. <\/p>\n\n\n\n<p>Please, if you are unable to come for your appointment, you MUST ring us to cancel no less than 24 hours before your appointment time or you will not be able to book an appointment at this practice again. <\/p>\n\n\n\n<p><strong><a href=\"http:\/\/khoo.com.au\/index.php\/the-pfizer-comirnaty-vaccine\/\">All you need to know about Pfizer Comirnaty vaccine<\/a><\/strong><\/p>\n\n\n\n<p><a href=\"http:\/\/khoo.com.au\/index.php\/after-your-pfizer-comirnaty-vaccination\/\"><strong>After your Pfizer Comirnaty vaccination&#8230;<\/strong><\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>You need to ring the practice on 9829 3033 to get a tentative appointment time before filling this form. Your appointment is not confirmed till we receive your consent form above. We will email or text you the confirmed appointment time and date. If you do not receive confirmation within<span class=\"more-link\"><a href=\"https:\/\/khoo.com.au\/index.php\/pva\/\">Continue Reading<\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/landing.php","meta":{"footnotes":""},"class_list":["entry","author-chee1404","post-2140","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/pages\/2140","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/comments?post=2140"}],"version-history":[{"count":12,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/pages\/2140\/revisions"}],"predecessor-version":[{"id":2161,"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/pages\/2140\/revisions\/2161"}],"wp:attachment":[{"href":"https:\/\/khoo.com.au\/index.php\/wp-json\/wp\/v2\/media?parent=2140"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}