Flu Vaccine

FLU VACCINATION CONSENT FORM FOR OVER 18

We are now offering the Influenza QIV vaccination for ages 18 and over in Rosscarbery Pharmacy

 

 

If you are over the age of 18 and have NOT yet received a Flu vaccine, please contact us by phone (083-4397126) to be added to our waiting list. 

ONCE YOU HAVE AN APPOINTMENT CONFIRMED BY A MEMBER OF STAFF, you can fill out the consent form below. This form only applies for the over 18 age categories. There is a separate form for the 2 - 17-year-old category. Please do not fill out the form unless you have a confirmed appointment as this will be null and void.

Before you fill out the consent form, please read the patient information leaflet relevant to your influenza vaccine and the HSE Influenza vaccination leaflet(s) relevant to your age & condition:

• Patient information leaflet for influvac
• HSE Information Leaflet for Healthcare Workers
• HSE Information Leaflet for At -Risk Group
• HSE Information Leaflet for Pregnant Women