Immunisation Records Update – Boroondara eForms

1Introduction

2Request details

3Contact details

You can use this form to:
- Update the AIR with missing or overseas immunisation records and if required have a catch up schedule developed
Before you begin:
- Ensure your child/family is living in Melbourne, or will arrive within 3 months of filling in this form.
- Tell us your name, email address and phone number
- Tell us your Medicare number (if you have one)
- Supply copies of your child's missing or overseas immunisation records
- Read the City of Boroondara Privacy Statement
After you complete this form we will:
- Send you an email confirming we have received your request
We may contact you about your request, if required.

What happens with your information?
- We record your information on our customer databases and make it available to relevant Council staff in line with our Privacy Policy

Your personal and health information is being collected by the City of Boroondara for the purpose of updating the Australian Immunisation Register (AIR) with missing or overseas immunisation records and if required have a catch up schedule developed. The information will be used by Council and its contracted service providers for that primary purpose or a directly related purpose and shall be disclosed to relevant Council staff. It will not otherwise be used or disclosed unless that use or disclosure is permitted or required by law. You may apply for access and/or amendment of the information by writing to Council’s Privacy Officer.
Consent * Required
- I consent to the collection/use of my information on this form.
This immunisation request is for * Required
First name Last name
Their date of birth * Required
DD slash MM slash YYYY
Their gender
- Male
- Female
- Other
Does the applicant have a Medicare card? * Required
- Yes
- No
Please provide the Medicare card number * Required
Medicare card individual reference number * Required
The number that appears beside the person's name on the card
In which country did your child receive their previous vaccinations? * Required
Select the country
Please upload your child's immunisation history records for assessment and updating on the Australian Immunisation Register (AIR)
You can upload a maximum of 4 files at 3MB each.
Allowed file types: jpg, jpeg, png, doc, docx, pdf
Drop files here or

Accepted file types: jpg, jpeg, png, doc, docx, pdf, Max. file size: 3 MB, Max. files: 4.
Maximum file size - 3 mega bytes.

Your name * Required
First name Last name
Email * Required
Enter Email Confirm Email
Phone number * Required
Address * Required
Street address or PO Box Address line 2 Suburb / City State Post code Country
How would you like to receive the information?
- Email (please allow 7 business days)
- Post (please allow 7 - 10 business days)
- Pick-up at Council reception - 8 Inglesby Road, Camberwell (please allow 7 business days)
I have read and accept Council's Privacy Policy and understand how my information will be used. * Required
- Yes
Address
Street address or PO Box Address line 2 Suburb / City State Post code Country
Email
This field is for validation purposes and should be left unchanged.