Please download and print this form.
You need to fill this form in and bring it with you when you only want to get your flu vaccine.
On the paper copy of the form:
- Add your NHS number – if you don’t know it, you can find your NHS number online or on your NHS App.
- Add your payroll number – your payroll number can be found by logging in to ESR and is on your payslip as ‘assignment number’. If you are not paid by the trust (for example junior doctors), you can leave the payroll number blank but you must add your NHS number.
Take the paper copy of the form with you – this will make the process much quicker for you. Vaccine forms can also be completed at our drop-in clinics but you will need to bring the above information.
- Remember to bring your staff ID badge.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email [email protected] to tell us what format you require. It will help us if you let us know what type of assistive technology you use.