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Step 3 of 3
Final Confirmations
Please confirm you understand the following before submitting the consultation.
Do you have any allergies or sensitivities (including to yeast or any vaccine components)?
*
Yes
No
Are you currently unwell or do you have a fever?
*
Yes
No
Is there anything else you feel would be useful for the clinician to know?
*
Yes
No
Do you agree to the following?
*
You will read the patient information leaflet supplied with the vaccine
You will contact us and inform your GP if you experience any side effects or adverse reactions following vaccination
The vaccination is for the named patient only
You have answered all the above questions accurately and truthfully. You understand our clinicians take your answers in good faith and base their decisions accordingly, and that incorrect information can be hazardous to your health.
I agree
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