Boots Colleague Hepatitis B Questionnaire

FOR BOOTS COLLEAGUES NOT ELIGIBLE FOR THE BOOTS HEPATITIS B VACCINATION SERVICE PROVIDED THROUGH BOOTS TRAVEL STORES

Following Boots Company guidance, you have been instructed to contact Doctorcall to arrange for a Hepatitis B Immunity test, or to be assessed by Doctorcall in view of your vaccination history. In order to complete an assessment you will require details of your Hepatitis B vaccination history (with dates).

In order for us to advise you of your nearest network clinic and give you details of how to arrange your appointments we need you to register with Doctorcall by completing the form below.

First Name* Surname* Date of Birth*

Gender MaleFemale

Address* Email address* Please provide an email address to which you are happy to receive personal information Daytime Telephone Mobile Telephone* Staff number* Job Title

Question 1.

Have you had a complete course of hepatitis B vaccinations through Boots Hepatitis B Vaccination Services for Boots Colleagues or another provider and now require a Hepatitis B Immunity test?

Yes You do not need to answer any further questions, please press the Submit button at the bottom of this page. Doctorcall will contact you shortly with instructions for arranging your Hepatitis B Immunity test. No You will need to complete your course of Hepatitis B vaccinations. Please answer Question 2.

Question 2.

Have you had any Hepatitis B vaccinations in the past?

Yes Please answer Question 3. No Contact your nearest Boots travel pharmacy and make an appointment to access the Boots Hepatitis B Vaccination service for Boots Colleagues. You do not need to answer any further questions, please press the Submit button at the bottom of this page.

Question 3.

Have you had an anaphylactic reaction to the ingredients of hepatitis B vaccine in the past?

Yes You should not have another hepatitis B vaccination. You do not need to answer any further questions, please press the Submit button at the bottom of this page. No Please answer Question 4.

Question 4.

When have you had Hepatitis B vaccinations previously?

Please provide details of any Hepatitis B vaccinations you have had, with dates.

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Additional Information

1 to 4 months after completing a primary course of Hepatitis B vaccinations, you will be given a Hepatitis B immunity test. Once immunity has been established you will require booster at 5 years.

5 years after completing a primary course of Hepatitis B Vaccinations, you should arrange for a 5 year booster from a Boots Travel Vaccination Pharmacy.

If you had vaccinations in the past as part of a primary course of Hepatitis B vaccinations which was not completed, you may need to start the primary course again. Doctorcall will advise depending upon the information you have provided.

If you have any queries, please contact the Doctorcall Medical Assistance Team by email at Boots@doctorcall.co.uk, or by fax on 0161 834 5827 quoting your full name and date of birth in all correspondence.

I declare that to the best of my knowledge and belief, the information contained herein is complete and true.

Boots Colleague Hepatitis B Questionnaire