Lake Cathie Pharmacy - Vaccinations

Flu shots, Influenza, no appointment necessary, quick, MMR, Whooping cough

Our pharmacists are trained to provide vaccinations for the following conditions, without the need to book an appointment:

Influenza Vaccinations (Flu)
Measles Mumps Rubella (MMR)
Diptheria, Tetanus, Pertussis (Whooping cough)

Certificates to visit Nursing Homes can be printed or emailed during the consultation.

If you would like to learn more about the vaccinations we offer, simple reach out to us using the contact form below or complete the Flu Vaccination form beow that!

Flu Vaccinations available now!

1. Personal Details (Person to be Vaccinated)

Full Name

Address

Email

Contact Phone Number

Medicare Number

Date of Birth

Gender

2. Primary Medical Practitioner (Optional)

Doctor

Doctor Phone

Doctor Email Address

Doctor Address

3. Pre-Vaccination Screening Checklist

(reference: Australian Immunisation Handbook)

Please indicate if you/ your child (the person to be vaccinated today):

Are unwell today (Yes/No)

Have a chronic illness (Yes/No)

Have a disease that lowers immunity (Yes/No)

(e.g. leukaemia, cancer, HIV/AIDS) or are having treatment that lowers immunity (e.g. oral steroid medicines such as cortisone and prednisone, radiotherapy, chemotherapy)

Have a history of Guillain-Barré syndrome (Yes/No)

Identify as an Aboriginal or Torres Strait Islander (Yes/No)

Are pregnant or planning pregnancy (Yes/No)

Have a bleeding disorder (Yes/No)

(or take any medications which may increase the risk of bleeding)

Do not have a functioning spleen (Yes/No)

Are a parent, grandparent or carer of an infant ≤6 months of age (Yes/No)

Have ever fainted after having an injection? (Yes/No)

Have had a severe reaction following any vaccine? (Yes/No)

Have any severe allergies to anything (anaphylactic) (Yes/No)

Had any blood transfusions in the past year? (Yes/No)

Please list below any vaccinations you have received in the last month

4. Consent to receive Influenza (Flu) Immunisation

I have been given, and understand the information provided to me regarding the vaccine and possible side effects.

If I have further questions, I will ask the immuniser before myself/my child is immunised.

I consent to myself/my child receiving the influenza vaccination.

I understand:

I/my child must remain within the pharmacy premises for a period of 15 minutes after vaccination for observation and so that I may receive additional medical attention, including emergency care, if needed.
This service will be recorded on the Australian Immunisation Register.
I have been advised of, and agree to pay the charges associated with this service.

I consent to a copy of my Statement of Immunisation being provided to my nominated medical practitioner (Yes/No)

Name

Date

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(02) 6585 5085 (02) 5504 5959