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Watton Medical Practice NHS GP Surgery in South Norfolk

Flu vaccination and appointment request

Flu Vaccination Appointment Request

Section

Confirmation *

I confirm I have added the most up to date phone number

If you are using a UK mobile number, please use the format 07xxxxxxxxx

Smoking status:

Smoker

Ex Smoker

Never Smoked

Smoker

How many do you smoke a day?

Would you like help to give up smoking?

Yes

Ex Smoker

How many did you smoke a day?

When did you give up smoking?

Do you vape?

Yes

Ex Vaper

How often do you vape?

What nicotine strength and intensity do you vape?

For applicable devices

Eligibility

If you would like to have the vaccine, please choose the appropriate option below and you will be contacted when your age group is eligible: *

65 years and over

18 to 64

Under 18

Please note that your cohort may not be eligible for several months.

I have a long-term health condition

I confirm that I would like a flu vaccination

If you are human, leave this field blank.

24 Gregor Shanks Way
Watton
Thetford
IP25 6FA

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01953 881247

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