Don Medical - Flu Immunisation Consent Form - 2021

Details of person to be Immunised

Public Influenza Eligibility Checker

Examples of chronic conditions are: Respiratory Conditions (Asthma, COPD etc), Diabetes, Cardiac (Heart) conditions, Cancer, Chronic Mental health Issues, Chronic Neurological conditions (eg MS, Seizures, ), Renal disease, Obesity

As you answered YES to one of the above questions, you are eligible for a Public funded Flu vaccine. Your vaccine will be provided free.

If you have your Flu immunisation in a dedicated "Flu Clinic", your consultation will be Bulk billed. It is a short visit only for your immunisation. No other Medical issues or repeat requests can be dealt with at this tme.

If you have your immunisation in a standard booked consultation time, normal fees apply for the consultation.

As a patient safety requirement, All patients having vaccines are required to wait 15 minutes in the practice before leaving.

As You answered NO to all the above questions you are NOT ELIGIBLE for a Public Government funded vaccine.

You will be eligible for a PRIVATE funded vaccine.

The Cost will be $20.00 for the vaccine

If this vaccine is provided in a dedicated "Flu Clinic" setting, the consultation will be Bulk billed to Medicare. At a Flu Clinic appointment, you will not be able to discuss other Medical issues as they are quick immunisation appointments only.

If you have your vaccination at a standard appointment, normal consultation fees apply.

Private Immunisations can also be booked with our Practice Nurse for a non-rebatable fee of $25.00 that includes the visit and the vaccine.

After all immunisations you arer required to wait 15 minutes after as a safety requirement.

As you answered UNSURE about your Chronic medical Condition, please check with your GP to determine if you are eligible. 

If you are deemed to be NOT ELIGIBLE for a Public Government funded vaccine.

You will be eligible for a PRIVATE funded vaccine.

The Cost will be $20.00 for the vaccine

Private Immunisations can also be booked with our Practice Nurse for a non-rebatable fee of $25.00 that includes the visit and the vaccine.

If you are deemed to be ELIGIBLE for a public funded "free" vaccine. The vaccine will be no cost to you.

If this vaccine is provided in a dedicated "Flu Clinic" setting, the consultation will be Bulk billed to Medicare. At a Flu Clinic appointment, you will not be able to discuss other Medical issues as they are quick immunisation appointments only.

If you have your vaccination at a standard appointment, normal consultation fees apply.


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Please Sign Below to verify your consent to the Flu Immunisation