Consent
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Consent form Please read and accept the information below before we can continue to the form

This portal is for the completion of the consent form for the flu vaccination for your child. The form is an electronic version of the paper consent form previously used and is for consenting and not consenting for your child in relation to the flu vaccination.

PLEASE READ ALL OF THE INFORMATION ON THE LINK BEFORE SELECTING “CONTINUE”.YOU WILL THEN BE GUIDED TO THE ELECTRONIC CONSENT FORM WHICH NEEDS COMPLETING TO CONSENT/NOT CONSENT FOR YOUR CHILDS VACCINATION

By clicking the Continue button below:

- 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 flu vaccine

    Flu Leaflet    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/907433/Protecting_Child_Against_Flu_DL_leaflet_2020.pdf

    Patient Information Leaflet   https://www.medicines.org.uk/emc/product/3296/pil

    Post Immunisation advice  https://www.covwarkpt.nhs.uk/service-detail/health-service/immunisation-and-vaccination-service-school-age-120/

- 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 School Aged Flu Vaccination Programme 2020.

If you have any queries please contact the immunisation team using the contact details below.

Yours faithfully

Coventry & Warwickshire Partnership Trust Immunisation Team

COVENTRY IMMUNISATION TEAM: 02476 961422

NORTH WARWICKSHIRE IMMUNISATION TEAM: 02476 321550

SOUTH WARWICKSHIRE IMMUNISATION TEAM: 01926 406738


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