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

If you have received an invitation for a Shingles Vaccination this year - then we would recommend that you come in to the surgery as it can be very important to help you stay well.

If however, you are really sure that you do not wish to have a Shingles 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. First Name

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* 2. Last Name

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* 3. Date of Birth

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* 4. I have been recommended to have a Shingles Vaccination - however I have decided that I do not wish to have one.

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* 5. Do you have an email address?

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