Health check for your COVID-19 vaccination registration on Bonaire

Bonaire has started to vaccinate its residents for COVID-19. All residents of Bonaire who are 18 years and older may be vaccinated*. We are using the following vaccination schedule. However, this may change if more vaccines become available or there are fewer available, or if the guidelines change. Please closely monitor the announcements in the local media: it may be possible that matters will move forward faster than initially expected, and that it will be your turn sooner than you thought. Starting from 22 February 2021: all health care workers. Starting from 1 March 2021: all residents age 60 years and over. Starting from the beginning of May 2021: all other persons aged between 18 and 60 years.

You must register by completing the form below before we start vaccinating the group you belong to.

After completing the form you must press the ‘send’ button:

  • in most cases your browser will generate a pdf that you should retain.
  • you will receive an email with a copy of the data you have entered. You should retain this email.
  • if you do not enter an email address you will not receive an email response.

If you enter an email address, you will receive a message from us within two working days with the date of your vaccination appointment. If you do not enter an email address, we will contact you within two working days on the phone number you have entered and we will inform you of your vaccination appointment. If you do not hear from us within three working days, please contact the Public Health Department call center via 0800 – 0800 from Monday to Friday from 8 a.m. to 5 p.m.

Please bring the completed health check form with you to your vaccination appointment. If you have any COVID-19 related symptoms on the day of your vaccination appointment, stay at home and call 0800 – 0800 for consultation.

*If you are not registered on the island, or have not yet received an ID number, you will most likely still be eligible for vaccination. In which case please enter your passport number.

Enter the ID number without the dots between the numbers
Please answer these first five questions about your current situation. On the day of the vaccination appointment you will have to answer these questions again. If you answer one of the questions with 'yes', you will not be permitted to keep your appointment. In such a case you must contact 0800 - 0800. Yes No
1. Have you been tested positive for coronavirus in the last four weeks?
2. Have you presently got a fever of 38 degrees Celsius or higher?
3. Do you have coronavirus related symptoms such as a runny nose, cough, chest tightness, elevated temperature or fever, loss of smell or taste? If so, stay at home and have yourself tested for coronavirus.
4. Are you presently in home quarantine because of coronavirus?
Reasons:
  • You were in contact with someone who has coronavirus
  • You have received a notification through the CoronaDetector app
  • You have undergone a coronavirus test and are waiting for the result
  • You have been in a code orange or code red travel area
5. Do you have an appointment for another vaccination within seven days before or after your coronavirus vaccination?
Yes No
6. Will you be operated on under general anesthetic within four weeks of your first vaccination?
If the answer to question 6 is 'yes', you must reschedule your appointment until after the operation. To reschedule your appointment call the Corona call center, at 0800-0800.
Yes No
7. Have you ever fainted after a vaccination?
8. Have you ever had a serious allergic reaction?
Have you been treated for it?
Do you carry an EpiPen or a medical passport?
9. Have you (had) breast cancer?
Left
Right
10. Do you use anticoagulants/blood thinners?
If you do not know the answer to question 10, please put down 'yes'.
Please contact your family doctor two weeks prior to the vaccination and discuss whether you may be vaccinated and what further measures may need to be taken. You will only be vaccinated after contact with your family doctor.
11. Have you got a coagulation disorder?
Hemophilia
Von Willebrand disease
A shortage of blood platelets (thrombocytopathy/thrombocytopenia)
Other
12. Do you have epilepsy and have you ever had an epileptic seizure during fever or after a vaccination?
If you have answered 'yes' to questions 11 or 12, it is important that you talk to your family doctor. Please do this before you come to your vaccination appointment.
Yes No
13. I hereby give my consent for my data to be shared with the family doctor.
I hereby declare that all the data I have given is true and that I have not omitted any important information.