Peverell Park Surgery & University Medical Centre

Peverell Park Surgery, 162 Outland Road, Plymouth, PL2 3PX. Telephone: 01752 766644 | University Medical Centre: 01752 222341

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Telephone: Peverell Park 01752 766644 University Medical Centre 01752 222341

administration.peverellpark@nhs.net

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Children’s Flu Vaccination

You are here:
Home
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Children’s Flu Vaccination

Children’s Flu Vaccination

The children’s nasal spray flu vaccine is safe and effective. It’s offered every year to children to help protect them against flu.

Flu is caused by the influenza virus. It can be a very unpleasant illness for children. It can also lead to serious problems, such as bronchitis and pneumonia.

Children can catch and spread flu easily. Vaccinating them also protects others who are vulnerable to flu, such as babies and older people.

For further information click https://www.nhs.uk/conditions/vaccinations/child-flu-vaccine/

Children's Flu Vaccination Form

Before attending the surgery with your child for vaccination, please provide the following details and answer the general health questions below.
--- Child Details ---
Child's Name(Required)
First Last
Child's Date of Birth(Required)
--- Parent Details ---
Parent's Name(Required)
First Last
Address(Required)
House Number/Street Post code
Parent's Contact Phone Number(Required)
Please confirm that your child:
Is well today?(Required)
Has had no allergic reaction to any previous vaccines including the nasal flu vaccine?(Required)
Has never had a serious allergic reaction to anything that has resulted in admission to intensive care?(Required)
Is not allergic to gelatine or gentamycin (an antibiotic)?(Required)
Has never been admitted to intensive care with severe asthma and has not taken steroid tablets to control asthma in the last 14 days?(Required)
Has not been wheezing in the past 3 days (if asthmatic)?(Required)
Is not taking aspirin?(Required)
Does not suffer with any medical conditions that affect their immune system working normally?(Required)
Is not in close regular contact with a household member who has a weakened immune system (for example, someone undergoing cancer treatment or someone who has had an organ transplant?(Required)
If any of these apply, please provide details below:
Date Form Completed(Required)
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Peverell Park Surgery & University Medical Centre

Children’s Flu Vaccination

Children's Flu Vaccination Form

--- Child Details ---

--- Parent Details ---

Please confirm that your child:

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