Flu Vaccinations

Please see the NHS influenza vaccine page for information around who is eligible for free influenza vaccines in 2020-21.

Please note that later in the year, the flu vaccine may be given to people aged 50 to 64. More information will be available later in the autumn. However, if you’re aged 50 to 64 and in an at-risk group, you should not delay having your flu vaccine.

If you wish to have the flu vaccination provided by Leach Heath Medical Centre this year, please complete the below form to register your interest and help us plan our clinics. This is not a confirmation of an appointment; you will be contacted once clinics are set up to arrange an appointment. If you plan to have your flu vaccination from another provider such as a pharmacy this year, you do not need to tell us.

  • Flu Vaccination

Personal Information

Full Name

Date of Birth

Please tick why you are eligible for a free flu vaccination

• a heart problem
• a chest complaint or breathing difficulties, including bronchitis, emphysema or severe asthma
• a kidney disease
• lowered immunity due to disease or treatment (such as steroid medication or cancer treatment)
• liver disease
• had a stroke or a transient ischaemic attack (TIA)
• diabetes
• a neurological condition, eg multiple sclerosis (MS), cerebral palsy
• a learning disability
• a problem with your spleen, eg sickle cell disease, or you have had your spleen removed
• are seriously overweight (BMI of 40 and above)

If reason is not listed please state reason

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