Skip to content
9 Burwash Road, Hove, BN3 8GP
01273204905
Facebook-f
Instagram
Home
Services
Weight Loss
Erectile Dysfunction
Vitamin B12 Injection
Flu Vaccination
Earwax Removal
All Services
Travel Clinic
Private COVID Vaccination
Travel Clinic
Hajj and Umrah Vaccination
Speciality Vaccine
Antimalarials
Yellow Fever Vaccine
Vaccine Prices
Pharmacy First
Sore Throat
Earache
Uncomplicated UTIs
Sinusitis
Impetigo
Infected Insect Bites
Shingles
Blood Tests
Sexual Health
Sports Fitness
General Health
Men’s Health
Women’s Health
Allergy and Intolerance
Fertility
Hormones
Rapid Blood Testing – Result In 15 Minutes!
Home
Services
Weight Loss
Erectile Dysfunction
Vitamin B12 Injection
Flu Vaccination
Earwax Removal
All Services
Travel Clinic
Private COVID Vaccination
Travel Clinic
Hajj and Umrah Vaccination
Speciality Vaccine
Antimalarials
Yellow Fever Vaccine
Vaccine Prices
Pharmacy First
Sore Throat
Earache
Uncomplicated UTIs
Sinusitis
Impetigo
Infected Insect Bites
Shingles
Blood Tests
Sexual Health
Sports Fitness
General Health
Men’s Health
Women’s Health
Allergy and Intolerance
Fertility
Hormones
Rapid Blood Testing – Result In 15 Minutes!
Book Online
NHS Flu Form
NHS Flu Vaccination Service - Record Form
Patient's Details
First Name
Last Name
Address
Postcode
Telephone
Date of Birth
NHS No.
GP Practice
Patient's Emergency Contact
Name
Telephone
Relationship to patient
Any allergies
Eligible patient group
65 years or over
Chronic respiratory disease
Chronic heart disease
Chronic kidney disease
Chronic liver disease
Chronic neurological disease
Diabetes
Immunosuppression
Asplenia/splenic dysfunction
Pregnant woman
Person in long-stay residential care home or care facility
Carer
Household contact of immunocompromised individual
Morbid obesity (BMI ≥40)
Workers employed through Direct Payment of Personal Health Budget
Learning disability
Frontline Health & Social care worker
Hospice worker
Submit Now
