Notice to Decline Vaccinations

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Personal Details

I wish to DECLINE the following vaccinations:

I understand that by declining I will no longer receive invitations from the practice to these vaccination clinics.

Reason for declining:

Please Note: you are able to change your mind at any time and book your vaccination (s) should your circumstances change.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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