Under-vaccinated Patients

Appointment Request Form


This appointment request form is only designed for Magenta Health patients who are under-vaccinated. If you are a regular patient looking for your usual booking page please use this link.

Magenta Health recognizes its responsibility to protect immuno-compromised individuals who visit our clinic. This includes patients medically unable to be immunized, children too young to yet receive their vaccinations, the elderly, patients with cancer, pregnant women, and patients with diabetes.

Therefore, effective October 2017, intentionally under-vaccinated children may not book into any available appointment time-slot. Instead, please use the form below to send an appointment request to our staff. We will assign an appropriate appointment date and time and then advise you of it via the email address that we have on file for you.

This approach is taken to mitigate the risks associated with the co-mingling of under-vaccinated and immuno-compromised individuals within our waiting room and clinic generally. Our full Clinic Vaccination Policy is available here.

Acknowledgement *
Patient Name *
Patient Name
Notification *
Please provide the email address that is on fle with the clinic
Medical Urgency *