Flu Vaccination Consent Form

Visiting Us

Please adhere to COVID-19 social distancing regulations.
Please attend the Practice alone (where possible)
Please wear a face mask and sanitise on entry/exit to the Practice
You should NOT attend if you have any COVID-19 symptoms or have been in contact with someone who has tested positive within the last 14 days.

We look forward to welcoming you to our luxurious private medical centre which is based in Glasgow city centre, with only a convenient 5 minute walk from Glasgow Central Railway Station and 10 minutes walk from Queen Street and Charing Cross Railway Stations. There is plenty of on-street parking around the Glasgow Medical Rooms practice.

Glasgow Medical Rooms

211 St Vincent Street, Glasgow. G2 5QY

Opening Times

Monday – Friday: 9:00am – 5:30pm

Contact Details

Telephone: 0141 225 0140
Email: info@glasgowmedicalrooms.com

Personal Details

Title*

Surname*

First Name*

Middle Name

Date Of Birth*

Email*

Phone Number*

Mobile Number

Address

Address 1*

Address 2

City*

Postcode*

Please tick the box if you DO NOT wish us to store your information
Do Not Store

NHS Details

Name of GP

NHS No. (CHI NO.)

Surgery Name*

Surgery Phone*

Emergency Contact Or Next Of Kin

(Please provide details of who we should contact should you require assistance)

Surname*

First Name*

Relationship*

Phone Number

Mobile Number*

Patient consent

1. I agree to be given a flu vaccination by Glasgow Medical Rooms.

2. I confirm I have not already received a flu vaccination for this flu season.

3. I declare that the information I have given on this form is correct and complete.

Signature*

Date:*

211 St Vincent Street Glasgow. G2 5QY

Glasgow Medical Rooms - Private GP & Private Doctors

4.8

Based on 194 reviews

review us on

james gunn

17:15 24 Jun 24

Martin Macleod

17:29 18 Jun 24

Attended Glasgow Medical Rooms for a consultation with Dr O’Neil today. I had an excellent experience and would highly recommend.

Gary Bickerstaff

12:48 17 Jun 24

Very easy to deal with. Helpful staff and Doctors

Vincent Kelly

11:38 03 Jun 24

Excellent service and friendly staff for my offshore medical.

Gordon McKinlay

16:40 12 May 24

This is the second time I have visited GMR & the whole experience was just as good as the first. Dr O’Neill was friendly & made me feel at ease right away. The examination was carried out professionally & competently & although I need a second appointment I feel a bit more relaxed about it.

David Matthews

17:42 24 Apr 24

Absolutely fantastic service. All the staff and clinicians were extremely professional and efficient, and I was in and out quickly without feeling rushed or that anything important had been missed. Definitely highly recommend and will be back! :-)

andi elezi

11:36 04 Apr 24

Top notch care from Chris Wicks (Physiotherapist).He has been absolutely fantastic also considerate and very careful following my neck injury from a car accident and has made sure that i am being well looked after!If you require physiotherapy this is the place to go!

Jiaying Cao

22:47 14 Feb 24

Friendly and helpful staffs. They always with smile and helped me make the appointment. Dr Olga Morton is so nice and professional and always so so patient. She really helps me and makes me feel better mentally and physically. Highly recommended!!!

Mark Handley

08:48 12 Jul 23

Been having a medical issue and after a Google search I found this practice very close to my hotel. From appearance at first I thought I was in the wrong place because it seemed to me that it was upmarket. I was fearful that I would be sent to the public hospital but I have to wait 45 minutes to see a doctor. The girl on reception was very helpful. Very comfortable seating. And an offer of coffee or tea, not something I have been offered by other practices.