Young person's aged 2 - 17 years - Flu Vaccination - No Thank You Form

This form is to say - NO THANK YOU - to Flu Vaccination

If you or your child have received an invitation for a Flu Vaccination this year - then we would recommend that you or he or she comes in to the surgery as it can be very important to help stay well.

If however, you are really sure that you do not wish for you or your child to have a Flu Vaccination then please can you fill in the form below.

The NHS requires every surgery to invite patients for various types of appointment several times which costs us a huge amount of money every year. It is really important to reply to all our requests if you really do not wish to have an appointment. Thank you for helping us by completing this form.

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* 1. Young person's First Name

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* 2. Young person's Last Name

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* 3. Young person's Date of Birth

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* 4. Who is completing this form

I am the patient and I am aged 16 years or above

I am the parent or legal guardian of the patient and he or she is aged under 16 years