Complete the form below if you have had the influenza vaccination elsewhere (external to Alfred Health), or wish to decline the influenza vaccine.

OR to arrange a vaccination, contact the staff immunisation clinic on 9076 3323.

Thank you.

PLEASE NOTE: If you close the browser session prior to submitting your completed survey, an incomplete survey will be submitted. You will need to complete and submit another survey to ensure that your influenza status is updated.

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