Flu Vaccine

Eligibility For NHS Flu Jab

If you've not received an invitation, please check the Patient Access eligibility checker at https://www.patientaccess.com/flu

If it advises you that you are eligible, please continue with this form.

If you have completed our flu eligibility checker and you are not eligible, you can make an appointment for a private flu vaccination with your pharmacist.

Continuous Cough

If you have a fever, new continuous cough or loss of (or change to) your sense of taste or smell, you should not leave your home.

You should use the following link as soon as possible for advice on what action to take: https://www.patientaccess.com/coronavirus

Do not continue with this form as it will be rejected.

Consent
Allergy
Preference of which arm for the Injection
Book a flu vaccination

Please submit this form to your practice - they will contact you about attending for a flu vaccination appointment.

Please remember that if you develop fever, new continuous cough or loss of (or change to) your sense of taste or smell, you should not attend for your appointment.

Instead, please stay in your home and use this online symptom checker as soon as possible for advice on what action to take.

Please note that to protect other patients, you should wear a face covering whenever you attend your practice or pharmacy.

Personal Details
First Name of the person the appointment is for
Last Name of the person the appointment is for
Date of birth of the person the appointment is for

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Local Services, Let
Local Services, Let