M W PHILLIPS flu vaccination booking form

Book Your Flu Jab – Fast, Safe, and Easy!💉

Your Best Defence This Season! 🧣
💉 About This Service
Flu vaccinations are now available at M W Phillips Chemists for Winter 2025/26.
We offer both NHS-funded and private flu vaccines, depending on your eligibility.

You may be eligible for a free NHS flu jab if you:

Are aged 65 or over
Are pregnant
Have certain long-term health conditions
Live in a care home
Are a carer or live with someone who is immunosuppressed
Are a frontline health or social care worker
🔗 Check eligibility on the NHS website

💉💉 Flu and COVID Vaccination Together
If you are also eligible for a COVID-19 vaccination, many of our branches can administer both vaccines during the same appointment, subject to:

Store availability
Vaccine stock levels
Our team will confirm this with you at the time of your appointment.

If you are eligible for a free NHS flu vaccination, you will not need to pay.
If you are not eligible, we can still offer the vaccine as a private service.
Ready to book your vaccine? Just fill in the form below and choose a date and time that works for you — you’re only a few clicks away!
Patient Name*

First NameLast Name
Date Of Birth*

DayMonthYear
Important Notice Regarding Date of Birth

The date of birth you have entered indicates that you are under 18 years of age. This form is intended for individuals aged 18 or over.

Please double-check the date of birth you have provided.
If you are under 18, we kindly ask that you contact your local M W Phillips pharmacy for further guidance.

Please note that some of our branches are able to offer flu vaccinations to children aged 2–3 years. If you are interested in this service, we encourage you to get in touch with your nearest M W Phillips pharmacy for more information.
Patient Gender*

MaleFemale
Patient Email*
example@example.com
Patient Address*

First Line of Address

Street Address Line 2

CityState / Province

Postcode
Phone Number*
Please enter a valid phone number.
Select Your Branch*
Birmingham, Blackheath, 5 Clement Road, B62 9LR, 0121 561 2905*
Birmingham, Sutton Coldfield, Sutton Park Surgery, B73 6SP, 0121 353 9027*
Birmingham, Erdington, 273 Kingsbury Road, B24 8RD, 0121 377 6042*
M W Phillips COVID and Travel Vaccination Centre, Birmingham, Great Barr, 121 Shady Lane, B44 9ER, 0121 355 4200*
Birmingham, Great Barr, 599 Kings Road, B44 9HN, 0121 354 8048*
Birmingham, Great Barr, 158 Old Oscott Lane, B44 8TS, 0121 360 5867*
Birmingham, Great Barr, Aylesbury Surgery, B44 0DX, 0121 384 2293*
Birmingham, Handsworth, B19 1LH, 0121 551 3814*
Birmingham, Kingsheath, Kingsfield Medical Centre, B14 6AA, 0121 444 6234*
Birmingham, Kingstanding, 434 Kingstanding Road, B44 9SA, 0121 3731424*
Birmingham, Kingstanding, 26 Rough Road, B44 0UY, 0121 354 7176*
Birmingham, Kingstanding, 9 Twickenham Road, B44 0NN, 0121 373 2754*
Birmingham, Quinton, 5 Dwellings Lane, B32 1RJ, 0121 421 6840*
Birmingham, Quinton, Selcroft Avenue, B32 2BX, 01214276060*
Birmingham, Smethwick, Smethwick Medical Centre, B66 3BQ, 1215580244*
Birmingham, Sutton Coldfield, 517 Jockey Road, B73 5DF, 0121 355 2122*
Coventry, 373 Green Lane, CV3 6EJ, 02476 414 722*
Coventry, Binley, 110 Brandon Road, CV3 2JE, 02476 449 642*
Coventry, Foleshill, 471 Stoney Stanton Road, CV6 5EA, 02476 680 399*
Coventry, Foleshill, 2 Queen Marys Road, CV6 5LL, 02476 688 384*
Coventry, Foleshill, 17 Station St East, CV6 5FL, 02476 665 272*
Leegomery, Leegomery Local Centre, TF1 6XQ, 01952 222 164*
Rowley Regis, Blackheath, 396 Long Lane, B65 0JF, 0121 559 2579*
Shenstone, 33b Main Street, WS14 0LZ, 1543481319*
Tamworth, 29 Ellerbeck, B77 4JA, 01827 896 464*
Walsall, 111 Buxton Road, WS3 3RT, 01922 495188*
Warwickshire, University Of Warwick, CV4 7AL, 02476 572 860*
Warwickshire, Binley , 47 Woodlands Road, CV3 2JL, 02476 544 073*
Warwickshire, Leamington Spa, 33 Oxford Street, CV32 4RA, 01926 424 796*
Warwickshire, Wolston, 12A School Street, CV8 3HF, 02476 540 959*
Do any of the following apply?*

Frontline Healthcare staffCarer (care home staff or Unpaid carers)Care Home ResidentPregnantChronic respiratory diseases (COPD, Severe Asthma and others)Chronic heart diseaseChronic kidney disease (Stage 3 to 5)Chronic liver diseaseChronic neurological conditionsDiabetes (type 1 or 2)Immunosuppression (Due to medication (e.g. chemo, steroids), HIV, asplenia)Morbid obesity (BMI ≥ 40 kg/m²)Household Contacts of Immunocompromised Individuals (e.g. cancer patients, transplant recipients)None of These Apply
Based on your responses, it looks like you might not be eligible for a free NHS flu vaccination.

But don’t worry — we can still help protect you.
We’re happy to offer the flu jab as a private service for just £20.00.
We’ll double-check your NHS eligibility when you come in, just to be sure.
Would you like to hear from M W Phillips about future vaccination campaigns and offers on our pharmacy services by email? M W Phillips offers a wide range of healthcare services, including seasonal vaccination clinics and health advice. We would love to keep you informed about relevant updates and promotions by email. Please let us know if you're happy to be contacted.*

Yes – I would like to receive updates about services and offers by emailNo – I do not wish to be contacted

Book Your Flu Jab – Fast, Safe, and Easy!💉