Reason for free NHS flu jab eligibility (Over 18’s):
Please tick to confirm that the person attending the appointment understands that they should:
- Please wear a face covering for your appointment (unless excempt).
- Please wear a short sleeved top for your vaccination.
- Please do not attend the pharmacy if you have flu-like symptoms or if you have been around someone who has had flu-like symptoms within the last 14 days. We can rearrange your appointment.
- Please aim to arrive at your booked appointment time.
- If you are eligible for a free NHS flu jab, you must have filled out this pre-consultation questionnaire prior to your appointment.
If you need to reschedule or cancel your appointment, please contact us at:
firstname.lastname@example.org or call us on
0113 487 3977 as soon as possible.
- If you pay for your flu jab, please bring a contactless payment method or card as we cannot accept cash payments.
Please review our guidance and triage questions that will be asked when you are booking your appointment:
- Are you currently suspected of having COVID-19?
- Have you been in contact with or are living with someone suspected or confirmed of having Covid-19?
- Do you have a fever, or have you had a high temperature in the last 14 days (a fever is a temperature greater than 37.8 degrees?
- Have you had a cough or any other respiratory signs in the last 14 days?
- Have you lost the sense to smell or taste in the last 14 days?
- Do you suffer from any of the following? Diabetes, cardiovascular disease, including hypertension, chronic lung disease, immunodeficiency, cancer under active treatment?
- Are you pregnant?
- Are you or anyone in your household awaiting a COVID test?