Flu Nurse booking request form

Please complete all of the sections below and submit your form to book. You may find it helpful to read our FAQ’s at the bottom of the page prior to completing the form.
If you have any questions or want to book for multiple sites please contact the flu team on 0345 6090 115^.

* indicates a mandatory field.

Company details
Main contact details
Invoice details
Bupa will contact you a day or two before your clinic to confirm the quantity of vaccines required.
Please confirm that all sites are suitable for the nurse and your employees on the day

The room should have:
• two chairs
• a small table
• a phone
• a waiting area with chairs outside
• JJ curtains or blinds on windows for privacy
• a large bin for waste paper

Please confirm that all sites are suitable for the nurse and your employees on the day


Is the room big enough to fit all of the above and space for employees to lie down if needed


The nurse will be introduced to a contact on the day who can help with any problems


The nurse will be introduced to the first aider on the day


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