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New Collegiate Medical Centre NHS GP Surgery in Manchester

Flu vaccination request

Flu Vaccination Request

Section

Please select from the following: *

I wish to attend for a flu vaccination, and I understand that I will get a text message to advise me of the time I should attend

I wish to decline the flu vaccination

Eligibility

You’re eligible for a free NHS flu vaccination, if you fall into one of the below categories. Please tell us which of the following apply to you: *

I am over 65 years

I am pregnant

I have a lung condition such as COPD, emphysema or bronchitis

I have severe asthma requiring the use of a steroid inhaler or tablets

I have chronic heart disease

I have chronic kidney disease

I have a chronic neurological condition e.g. Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy

I have a learning disability

I have diabetes

I have Splenic dysfunction or asplenia

I have a weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment)

I am morbidly obese (defined as a BMI of 40 and above)

I am a Child aged under 4 years of age

I am aged 50-64

I am a registered carer

I am under 18 years of age

I am unsure if I am eligble

Please provide more details: *

If you are human, leave this field blank.

407 Cheetham Hill Road
Cheetham
Manchester
M8 0DA

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0161 205 4364

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