Children’s Flu Vaccine Booking Form

Data Protection Notice: Personal data collected by this website and the HSE PCRS (Primary Care Reimbursement Service) is used for the purpose of providing a health service. It is required, stored, processed and disclosed to other bodies in accordance with the provisions of GDPR (General Data Protection Regulations) relating to proper treatment of personal data. I have answered all the questions above in a truthful and accurate manner. I agree to accompany a patient whom is 6 months-16 years of age as a Guardian /Parent to give consent when they are receiving their flu vaccination in the pharmacy. I acknowledge verbal consent will be given on the day of vaccination should I / child wishes to proceed with vaccination once all my queries have been answered satisfactorily. I also agree to wait in a designated area for 15 minutes post vaccination near the pharmacy for observation purposed