COVID Vaccination Request

This is a request for a COVID-19 vaccination form, we will be strictly following national and local guidance as to which age  and clinically “at risk” groups are currently being vaccinated. For those with mobile phones we will send you a text message with a link to this page when you become eligible for a vaccination.

COVID-19 vaccinations are being administered from designated centres:

  • Lionwood Medical Practice, Wellesley Avenue North, NR1 4NR
  • Gurney Surgery, 40 Fishergatre, NR3 1SE

Please wear a face covering when attending the appointment. Do not attend if you are unwell or have COVID-19 symptoms.

Please do try and keep to your allocated time slot.

COVID Vaccination Request



This is for patients registered with Magdalen Medical Practice.


This is for a COVID-19 vaccination. COVID-19 vaccination clinics are run on Monday to Saturday.

Please tick which vaccination centres you could get to:
Please tick which days you could attend for a vaccination:
Please specify your preferred time:


Please specify the ethnic group you consider you belong to: *

Terms and Conditions