Flu Vaccination Consent Form

Please confirm your consent for your child's Seasonal Flu vaccination. If you choose Yes, a list of clinical questions will be displayed that are relevant for this vaccination. If you choose No, a list of options will be displayed for you to tell us why you do not want your child to receive the Seasonal Flu vaccination.

The nasal flu vaccine contains products derived from pigs (porcine gelatine). To opt for the porcine gelatine free inactive flu injection, select NO to the nasal flu immunisation and you will be given further options. More information for parents is available from www.nhs.uk/child-flu.

I consent for my child to receive the Flu nasal spray immunisation:

Yes

This is a required field

Please let the vaccination team know if your child has had to increase their asthma medication after you have returned this form.

On the day of vaccination, please let the immunisation team know if your child has been wheezy in the past three days or has taken steroids in the past two weeks to treat their asthma.

The nasal flu vaccine contains products derived from pigs (porcine gelatine). Please contact us to discuss an alternative flu vaccine. More information for parents is available from www.nhs.uk/child-flu