Flu Vaccination Record Form 2022/23

To be completed if you have been vaccinated outside of SaTH.

Last updated: 18 October 2022 at 11.26am

Your information

I understand that by submitting this information it will form part of anonymised flu uptake data reporting.
Name(Required)
Date of Birth(Required)
Gender(Required)
e.g. GP practice or local pharmacy
When Were You Vaccinated?(Required)

* Please note if correct Employee Number is not provided it will not be possible to issue a voucher.