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Vaccine Services

Flu Vaccine

Covid-19 Spring Booster

Click on the images above to view more information on the Vaccines available in our Pharmacies

Fill out the Vaccine Questionaire below to Register for a Vaccine in one of our Pharmacies

Vaccine Questionaire

What Vaccine/s are you interested in? (Tick vaccines required)

Flu Vaccine Covid19 Spring Booster Vaccine

In which Pharmacy do you want to receive your vaccine?

Daarwood Pharmacy Newcastlewest Southside Pharmacy Roxboro Ballycasey Pharmacy Shannon Woodview Pharmacy Cratloe Hickeys Pharmacy Johns Square

Email

Name

Address

Phone Number

Date of Birth

Your GP's Name & Address

PPS Number

Are you a Medical card Holder?

Yes No

Select the category that applies as to why you require the Flu Vaccine

Aged 65 years and over Aged between 2 years and 18 years old (Fluenz Nasal Spray) Pregnant Woman Healthcare Worker - Medical/Dental Healthcare Worker - Nursing Healthcare Worker - Health & Social Care Staff Healthcare Worker - Management / Administration Healthcare Worker - General Support Staff Healthcare Worker - Other A - Chronic Respiratory Disease C - Chronic Heart Disease D - Chronic Renal Failure E - Chronic Liver Disease F - Chronic Neurological Disease G - Immunosuppressed (due to disease or treatment) H - Household contacts or out of home carer ( to persons of increased medical risk) I - Diabetes Mellitus J - Morbidly Obese K - Haemoglobinopathies L - Children with conditions that compromise respiratory function M - Resident of a nursing home or other long stay facility O - Carers P - People in close contact with pigs, poultry or water fowl Q - Children on long term Aspirin therapy AL - Down Syndrome CN - Clinical risk necessity for a second dose None of the above

Are you Pregnant?

Yes No

Have you had breast surgery?

Yes No

Are you allergic to Eggs or Chicken

Yes No

Any you allergic to any of the vaccine residues or excipients?

Yes No

Have you ever had an allergic reaction to a previous vaccination?

Yes No

Have you ever suffered from an Anaphylaxis Reaction?

Yes No

Please give details of any current medical conditions, allergies or are you taking any medicines?

Have you had any exposure to Covid 19 in the last two weeks?

Yes No

Do you feel unwell in any way?

Yes No

Have we partnered with your employer for you to receive the Flu Vaccine?

Yes No

If you answered yes to the question above who is your employer?

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Registered Internet Pharmacy

SERVICES

Prescription Services
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Online Doctor Ireland
Ask Our Pharmacist
Med-Easy Pill Pouches
Care Home Support

Prescription Services
Vaccine Services
Online Doctor Ireland
Ask Our Pharmacist
Med-Easy Pill Pouches
Care Home Support

INFORMATION

About Us
Careers
Locations
Contact Us
Terms & Conditions
Privacy Policy
Registered Internet Pharmacy

About Us
Careers
Locations
Contact Us
Terms & Conditions
Privacy Policy
Registered Internet Pharmacy

SERVICES

Prescription Services
Vaccine Services
Online Doctor Ireland
Ask Our Pharmacist
Med-Easy Pill Pouches
Care Home Support

Prescription Services
Vaccine Services
Online Doctor Ireland
Ask Our Pharmacist
Med-Easy Pill Pouches
Care Home Support

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Call us now on 069-69 525

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