Requesting an Appointment for Baby Immunisations

Request an Appointment for Baby Immunisations

Please complete this form to request or book your baby’s routine immunisation appointment. A member of our clinical team will review your request and send you a booking link to schedule an appointment.

Parent/Guardian Details

Name  Required
Address  Required

Child's Details

Name  Required
Date of Birth  Required
Gender  Required

Immunisation Type

Please indicate which vaccination you are booking for:  Required

Health Information

Is your child currently unwell (e.g., fever, infection, cough, rash)?  Required
Has your child had any severe allergic reactions to previous vaccines or medicines?  Required
Was your child born prematurely (before 37 weeks)?  Required
Are there any medical conditions we should be aware of?  Required

Additional Information

Carers

Chaperoning

GDPR, Data Processing and Subject Access Request (SAR)

Infection Control

Long Term Conditions

Summary Care Records

Zero Tolerance Policy

Non-NHS Services

Patient Participation Group

Responsibilities

Talking Saves Lives

Winter Health

Community and Locality Services

Complaints Policy