Skip to main content
FLU Vaccination Clinic
Full Name
*
First
Middle
Last
Email address (Please enter if you have one)
Email address
Confirm email
Please choose one
*
Yes, I want a FLU vaccination
No thank you
Consent
*
I understand that if I have responded ‘Yes, I want a FLU vaccination’ and I change my mind after submitting this form then the Company will recover the cost of the pre-ordered vaccination (£15.00) from me via a deduction from my wages.
I agree.
Email
This field is for validation purposes and should be left unchanged.
Close Menu