Flu Vaccine request 2020

Ardara Health Centre

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Firstname:

Surname:

Date of Birth:

PPSN:

Medical Card or Doctor visit card number:(if you hold a medical card)

Mobile:

Please select a category from the list below

HSE guidelines on "At risk Category"

By submitting this request you are agreeing
to us sharing you information with the Department of Health for a "legitimate purpose" .

Ardara Health Centre will text you at above mobile number with a date and time for your flu vaccination as soon as we receive the 2020 Vaccines.