Requesting an Appointment for Intramuscular Injections

Request an Appointment for an Intramuscular Injection

Please complete this form to request or book your routine immunisation appointment. A member of our clinical team will review your request and send you a booking link to schedule an appointment. Please do NOT use this form to request travel immunisations. The surgery does not provide this service. For more information, please visit: https://stmartinsmedicalcentre.co.uk/travel-vaccinations/

Name  Required
Address  Required

Immunisation Type

Please indicate which injection you are booking for:  Required

Health Information

Are you currently unwell (e.g., fever, infection, cold symptoms)?  Required
Do you have any known allergies (e.g., to medication, latex)?  Required
Are you currently pregnant or breastfeeding?  Required
Are you taking any blood-thinning medications (e.g., warfarin, apixaban)?  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