Reserve Your Flu Jab

Simply fill out the form below to reserve your flu vaccine.

Current Availability

Over 65 vaccine:

Under 65 vaccine:

Details of Person to be Vaccinated

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Address Details

Medical Details

Please note: this does not apply if you take oral anticoagulants like aspirin, warfarin or apixaban etc.


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Consent & Declaration

By signing the consent below, using your mouse on a PC or finger/stylus on a tablet or phone:

  • I agree to be given a flu vaccination by a trained pharmacist.
  • I declare that the information I have given on this form is correct and complete.
  • I confirm that I have not already received a flu vaccination this flu season.
  • I consent to the disclosure of relevant information, where appropriate from this form to: my GP practice to help them provide care to me, NHS England and the NHS BSA for the purposes of checking payments to the pharmacy and to allow them to ensure the service is being provided correctly.
  • I understand I will need to wear a mask or face covering to receive vaccination (COVID-19 regulations).

The following information will help you choose the correct eligibility for a FREE NHS Flu jab

65 years and over (or will be 65 by 31/March/2021)

Including those becoming age 65 years by 31 March 2021.

50 (or will be 50 by 31/March/2021) - 64 years AND none of conditions below apply

Public Health England have authorised vaccination of this new cohort from Tuesday 1st December 2020

Chronic (long term) respiratory disease, such as severe asthma, COPD

Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Over 18 years of age.

Chronic heart disease, such as heart failure

Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. Over 18 years of age.

Chronic kidney disease at stage three, four or five

Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation. Over 18 years of age.

Chronic liver disease

Cirrhosis, biliary atresia, chronic hepatitis. Over 18 years of age.

Chronic neurological disease e.g. Parkinson’s disease, motor neurone disease or learning disability

Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. Over 18 years of age.


Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. Over 18 years of age.

Immunosuppression, a weakened immune system due to disease e.g. HIV or treatment e.g cancer

Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder). Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day. It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of influenza and should be offered seasonal influenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician. Some immune-compromised patients may have a suboptimal immunological response to the vaccine. Over 18 years of age.

Asplenia or splenic dysfunction

This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction. Over 18 years of age.

Morbid obesity (BMI ≥40kg/m2)

Adults with a Body Mass Index ≥40kg/m2 Over 18 years of age.

Pregnant women (including those women who become pregnant during the flu season)

Pregnant women aged 18 or over at any stage of pregnancy (first, second or third trimesters).

People living in long-stay residential care homes or other long-stay care facilities

Vaccination is recommended for people aged 18 or over living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence. For the pharmacy service this only applies to those aged 18 or over.


People aged 18 or over who are in receipt of a carer’s allowance, or those who are the main carer of an older or disabled person whose welfare may be at risk if the carer falls ill.

Household contacts of immunocompromised individuals

People who are household contacts, aged 18 and over, of immunocompromised individuals, specifically individuals who expect to share living accommodation on most days over the winter and, therefore, for whom continuing close contact is unavoidable.

Social care workers

Health & social care staff, employed by a registered residential care/nursing home or registered domiciliary care provider, who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza. Vulnerable means those patients/clients in a clinical risk group for flu or who are aged 65 years and over. Over 18 years of age.

Hospice workers

Health and care staff, employed by a voluntary managed hospice provider, who are directly involved in the care of vulnerable patients/clients who are at increased risk from exposure to influenza. Vulnerable means those patients/ clients in a clinical risk group for flu or who are aged 65 years and over. Over 18 years of age.

Household contacts of those who are on the COVID-19 shielded patient list

This is awaiting clarification from NHS England

Employee of Portsmouth City Council/Gosport Borough Council/Portsmouth CCG

Employees of these organisations will be eligible for a free flu jab on presentation of valid staff ID. If you are eligible for a free NHS under the listed criteria, please choose an NHS exemption instead.