Decline an invitation

Form summary

Which type of appointment have you been invited to?

Health review

Vaccination

Name of vaccination

For example, flu, MMR, shingles

Health review

Name of health review

For example, asthma, diabetes

Do you want to decline all parts of the health review this year?

Yes

No

Which parts of the health review do you want to decline?

For example, having a blood test

I take full responsibility for declining this invitation. I understand that I can contact the surgery at any time if I change my mind.

Enter your signature to confirm:

Signature *

Date

Terms and conditions

I confirm that this is not an emergency and understand the surgery cannot help while it is closed. If I need help right now, I will use the NHS 111 service. In an emergency, I will call 999 or go to A&E.

Tell us whether you accept cookies

Form summary

Health review