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.

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.

This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please use self service, request someone to deal with us on your behalf, or contact us. We can help you access, complete and submit them.

Page last updated: 9 April 2022