Information Regarding Vaccination Booster (Third Dose) (as of 12/27/2021)

Necessary Documents for Vaccination Booster (Third Dose)

• Pre-vaccination Questionnaire with attached Certificate of Vaccination and Vaccination Coupon (be sure to fill out the necessary information and bring the entire document with you; do not tear off the coupon)
• Form of ID (health insurance card, driver’s license, etc)
• Those with a prescription record book (お薬手帳//okusuri techō) should also bring it with the items listed above.

Application for Vaccination Booster (Third Dose) Coupon

• Of those who have had seven or more months pass since their second vaccination, the following will need to apply to receive their vaccination booster coupon:

Those who must apply

• Those who have moved to Hiroshima City after being vaccinated in another municipality
• Those who have still not received their Pre-vaccination Questionnaire with attached Vaccination Coupon in the post eight or more months after their second vaccination
• Those whose address on their Resident Record has changed after the Pre-vaccination Questionnaire with attached Vaccination Coupon has been sent
• Those whose Pre-vaccination Questionnaire with attached Vaccination Coupon has been lost, destroyed, or damaged
• Those who used their vaccination coupons only to consult with doctors  
• Those who received both of their vaccinations overseas (*Note)
• Those who received both of their vaccinations from the US military in Japan (*Note)
• Those who received both of their vaccinations in clinical trials by pharmaceutical companies (*Note)

  *Note: Limited to those who received COVID-19 vaccinations from Pfizer, Takeda/Moderna, or AstraZeneca.

Necessary documents

• Application Form for Issue of Vaccination Booster (Third Vaccination) Coupon (COVID-19)
• One of the following documents to confirm you have received your first and second vaccination (copy acceptable):

  Certificate of Vaccination, Record of Vaccination for COVID-19, patient copy of your medical questionnaire

  Note: if your reason for applying is “Lost or damaged vaccination coupon” or “used vaccination coupon only to consult with doctor”, you do not need to provide the documents listed above.

• Form of ID (driver’s license, health insurance card, individual number card, or similar)
• If applying via proxy, a letter of proxy and ID for your proxy

Application form

• Download the application form here (Japanese).
• Note: an English translation of the form can be found here. This translation is for reference purposes only; please fill out and submit the Japanese form.

Where to submit your application

If submitting in-person

Bring your completed application and all necessary documents to either of the following:

• Health Promotion Division Temporary Office
  Hiroshima City Hall 16F
• Mutual Community Support Division of your local ward office

If submitting via postal mail

Health Promotion Division
Health and Welfare Bureau
The City of Hiroshima
1-6-34 Kokutaiji-machi, Naka-ku, Hiroshima
730-8586

Note: Please write “Application Form for Issue of Vaccination Booster (Third Vaccination) Coupon (COVID-19) Enclosed” in red letters on the envelope.

How/when you will receive your coupon

Issuance method

As a general rule, coupons will be issued via postal mail.

Issuance period

If you submit your application by the beginning of the seventh month after your second vaccination, your coupon will be sent at the end of the same month.

If you submit your application in or after the middle of the seventh month after your second vaccination, your coupon will be sent 2-3 weeks after the date you applied.

Please note that it may take more time to issue your coupon depending on circumstances such as processing a large number of applications, incomplete application forms, or other circumstances.