Corporate flu vaccine registration

Your employer has nominated you to receive a flu vaccination at Evercare this year.

In order to proceed we need to get some basic details from you so that we can record your vaccination and make sure the doctor has the necessary information to administer your vaccination.

Please complete the form below prior to your vaccine appointment.

Individual details

Please complete this form using your personal (not company) details as they may be used to communicate with you regarding your health care.

By completing this form you agree to Evercare medical centre using your information to provide the planned activity and contacting you regarding future medical services. You have read and agree to Evercare's Terms and Conditions and Privacy policy detailed here.