Flu Vaccination Record Form 2023/24

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

Your information

I understand that by submitting this information it will form part of anonymised flu uptake data reporting.

Date of Birth(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.