Kejriwal Nursing Home COVID-19 Vaccination Registration Form

Hello Everyone, With the second wave of the corona making rapid strides and spreading all over the nation, vaccination has become the ultimate need of the hour. Therefore, Kejriwal Stone Clinic and Kidney Care Centre has dedicated the 1st day of General vaccination (above the age of 18) on 1st May, from 8 am to 11 am for the first 50 people to register from our dear neighborhood families of Parnami Mandir Road exclusively. The cost of the vaccine(Covishield) will be Rs 250 per person and is subjected to change according to government rules and pricing. Our registration process will only be done through an online portal so that interested members can quickly fill their applications without any hassle. To avoid waiting in a queue for your turn to secure a Covid shot, We firmly request each member and their families to complete the overall registration process at the earliest so that a safe environment can be built and fear can be reduced.

Register Your Self

Name*

Phone No*

Aadhaar Card No*

Email (optional)

Age*

Date Of Birth*

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Address*

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