Flu Decline | redandgreenpractice

Flu Vaccination Decline Form

If you wish to decline the flu vaccination please complete and submit the form below.

For more information on the flu vaccination click here

I have already handed my BP in recently

I do not wish to have my BP taken

Decline Flu Vaccination

I DO NOT wish to receive the flu vaccination this year

Please tick this box before submission to acknowledge that this form is being sent un encrypted via the world wide web

The information you have completed in this form will be stored in the Wix Website Editing Software, which is accessed using the practice's Wix login via the world wide web, please tick this box to confirm you are happy for this information to be stored.

If you are not happy to tick the boxes above please complete the paper copy of the form, located on the back of your flu vaccination invite letter, and return it to the surgery. Alternatively, complete and print this page and hand in at your surgery.

Thanks for submitting. We will update your records.

Waterside Health Centre

The Red and Green Practice

Waterside (Hythe) and Blackfield Health Centres

Southampton

Partners in the Primary Care Network (PCN)

Blackfield Health Centre