Flu Vaccination Form

Your clinical history will be checked, prior to an appointment being booked. If you do not fall into one of the eligible categories, unfortunately you will not be eligible for the NHS flu vaccination here at the surgery.

Please contact your local community pharmacy for information and costs.

Due to the staggered delivery dates for our vaccinations, we are opening patient appointments on different dates as below:

  • Sept 2020 – Appointments are available for Over 65s
  • Oct 2020 – Appointments are available for all eligible patients

Only once we receive our guidance from NHS England, will we be able to open appointments to book childrens flu vaccinations. As per the current NHS information, please note that, if you are aged between 50 and 64 and not in a clinical at risk group, the earliest you will be offered a flu vaccination is November, providing there is sufficient vaccine. No appointments will be offered for people in this age group until then. This is to ensure that those who are most at risk are vaccinated first.

Flu Vaccination Form

Personal details:

Please enter the date in format DD/MM/YYYY
Please use the format email@example.com

Text consent:

The practice can send a text message to your phone with your appointment time. *

Ethnic group:

Please specify the group you consider yourself to belong to: *


You’re eligible for a free NHS flu vaccination, if you fall into one of the below categories. Please tell us which of the following apply to you: *
Please tell us your availability: *