Childhood immunisation disclaimer

Use this service if you do not want your child immunised against diseases.

Please read each statement carefully.

Your child can be restored to the vaccination schedule at any time by contacting the practice.

You can use this service if you:

  • are registered at the surgery

Before you start

You should read the Department of Health (DoH) reference guide to consent for examination or treatment before making a decision.

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
Start now

You can also phone us on 01451 830625.