Consent
Coventry and Warwickshire Partnership Trust Logo
Consent form Please read and accept the information below before we can continue to the form

This consent is for both consenting and not consenting for your child to have the recommended vaccination.

By clicking the Continue button at the bottom of this page:

I confirm that I have parental responsibility for the named child on this form

I have read and understood the information given to me about the relevant vaccine

For further information on the routine vaccinations delivered to school aged children and young people, please see below

  • Meningitis ACWY (Men ACWY)
  • Tetanus, Diphtheria and Polio (Td/IPV) Vaccinations
  • Human Papilloma Virus (HPV) Vaccination
  • Influenza (flu) Vaccination

PATIENT INFORMATION LEAFLETS

Men ACWY

Meningitis ACWY - Patient Information Leaflet (PIL)

Td/IPV

REVAXIS - Patient Information Leaflet (PIL)

HPV

Gardasil - Patient Information Leaflet (PIL)

INFLUENZA

Influenza - Patient Information Leaflet (PIL)

 

 

 

 

 

 

 

 Click here for more information on:

  • SECONDARY & PRIMARY SCHOOL VACCINATIONS
  • ADVICE FOLLOWING VACCINATION
  • DATA SHARING
  • CONSENT INFORMATION

I understand that information provided will be shared with their GP and CHIS.

I understand the data submitted as part of the e-consent form will be stored safely and securely on Coventry and Warwickshire Partnership Trust systems and only be used for the relevant Vaccination

If you have any queries, please contact your child’s immunisation team using the contact details below.

COVENTRY IMMUNISATION TEAM: Tel: 024 76 961422 Email: Bewise.Immunise@covwarkpt.nhs.uk

SOUTH WARWICKSHIRE IMMUNISATION TEAM: Tel: 01926 353899 Email: SOUTHIMMS@covwarkpt.nhs.uk

NORTH WARWICKSHIRE IMMUNISATION TEAM Tel: 02476 321550 Email: NORTHIMMS@covwarkpt.nhs.uk

 

Yours faithfully

Coventry & Warwickshire Partnership Trust Immunisation Team

 

By clicking continue, you are agreeing to the terms set out above