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 to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

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 June 2025.
QC 55977