Flu Vaccination Consent Form

I have read and understood the Influenza Vaccination Information Sheet supplied about the risks of Influenza vaccination including the risks of not being vaccinated. If I have any questions I will ask the immunisation provider prior to the vaccine being administered.
- Yes
- No
I request to be vaccinated against Influenza and I understand that this is completly voluntary and I can withdraw my consent at anytime prior to the vaccine being administered.
- Yes
- No
If you have any questions regarding this years Flu vaccination, please write your questions here. We will endeavor to contact you prior to your appointment (if possible) to answer these.