Flu Vaccination Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LayoutForename *Surname *Date Of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address *EmailConfirm EmailMobile Phone Number *Age (in Years) *Schools Name *Schools Postcode *URN Number *Are you in an eligible group to receive a free flu vaccination via the NHS? Categories include: *YesNo Aged 65 or over Have certain long-term health conditions Are pregnant Live in a care home Are the main carer for an older or disabled person Or receive a carer's allowance, live with someone who has a weakened immune system. NHS Number (if Known) GP NameGP AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeDoes your local Boots pharmacy offer flu vaccinations, and are there suitable appointment times available for you to book? *YesNoPlease check this before requesting a voucher. Vouchers can only be used at participating Boots pharmacies, and Education Mutual cannot guarantee appointment availability at your preferred location or time. You will receive a vaccination voucher within the next 48 hours. The voucher will be sent directly from Boots and may be delivered to your junk or spam folder. The voucher can only be redeemed at a Boots pharmacy and cannot be used at any other pharmacy. If you experience any issues booking or amending your appointment after receiving the voucher, please contact your local Boots pharmacy directly. Please ensure that your email address and telephone number are correct before submitting this form. Are you happy to proceed? *YesNoSubmit
