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Information about the health screening form for coronavirus vaccinations (translations)

Before you go to the vaccination centre, you must fill in a health screening form (in Dutch: gezondheidsverklaring). On the form are questions about your health. This information explains why you need to answer those questions. Available in English, Arabic, French, German, Polish and Turkish.

Download "English: Information about the health screening form for coronavirus vaccinations"

PDF document | 45 kB

Publication | 03-05-2021

Download "Arabic: Information about the health screening form for coronavirus vaccinations"

PDF document | 247 kB

Publication | 03-05-2021

Download "French: Informations relatives à la déclaration de santé pour votre vaccination anti-Covid"

PDF document | 45 kB

Publication | 03-05-2021

Download "German: Informationen zur Gesundheitserklärung für Ihre Coronaimpfung"

PDF document | 55 kB

Publication | 03-05-2021

Download "Polish: Informacje o oświadczeniu o stanie zdrowia przy szczepieniu przeciwko koronawirusowi"

PDF document | 48 kB

Publication | 03-05-2021

Download "Turkish: Korona aşınız sırasında sorulacak sağlık beyanı formu hakkında bilgilendirme"

PDF document | 274 kB

Publication | 03-05-2021

See also

  • Dutch vaccination programme against Covid-19
  • Coronavirus Covid-19 Topic

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  • Ministry of Health, Welfare and Sport

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