Reg. Forms & Info Sheets
For more information please call 0845 130 4595
You may download and print the registration forms
from here and then post them to us.
1. For single measles, mumps and rubella vaccines
The form above is a pdf document and may take a few minutes to download. Please click the link on the right to install Adobe Reader on your computer if required.
Please read the information carefully and call if you have any questions.
Fill the first 2 pages of the 'Clinic Copy' and send with the 'clinic use only' form to us with the registration fee and first vaccine fee.
2. For all other vaccines ( e.g. chickenpox, prevenar etc)
The forms and sheets above are pdf documents and may take a few minutes to download. Please click the link on the right above to install Adobe Reader on your computer if required.
Please read the information relevant to the vaccine you need and fill the registration form (first 2 pages only).
Send the completed registration form to us with the 'clinic use only' form. There is no registration fee applicable for these vaccines
3. Health Questionnaire for use with Telephone Consultations, Tamiflu, Botox or when registering for any other medications
The Booking Process
Call 0845 130 4595 to request an application pack or print from above.
Send the completed pack or Health Questionnaire (with the registration fee plus 1st vaccine fee if applicable).
The postal address is: Direct Remedies, Sunbury Clinic, 2 Burgoyne Road, Sunbury-on-Thames, TW16 7PW.
The fax number is: 01932 711 075.
We will contact you to book your appointment.
