Influenza vaccination request

Use this service to submit a influenza vaccination request.

You can use this service if you:

• are registered at the surgery

You will receive an appointment via email within 3 working days of submitting the form.

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of

Start now

You can also phone us on Millwood Surgery 01493 444484 or Falkland Surgery 01493 442233