Shingles Decline If you have been contacted by the Practice or are eligible to receive a free Shingles vaccination for this year’s Shingles campaign (eligibility below) and wish to decline please complete the following information. If you change your mind during the shingles campaign, you can still have the vaccine and can arrange this by contacting the Practice.Full Name First Last Date of Birth Day Month Year Email Enter Email Confirm Email Contact Number OptionalDeclaration I wish to decline I wish to decline as I have been vaccinated elsewhere People who should have a shingles vaccinationPlease follow the link below to check if you are eligible for the shingles vaccine, for information on who should not have the Shingles vaccine. Learn more at www.nhs.uk