5-in-1 (DTaP/IPV/Hib) vaccine 2 months old – Pneumococcal (PCV) vaccine 2 months old – Rotavirus vaccine 2 months old – 5-in-1 (DTaP/IPV/Hib) vaccine (2nd dose) 3 months old – Meningitis C 3 months old – Rotavirus vaccine (2nd dose) 3 months old – 5-in-1 (DTaP/IPV/Hib) vaccine (3rd dose) 4 months old – Pneumococcal (PCV) vaccine (2nd dose) 4 months old – Hib/Men C booster 12 to 13 months old – Measles, mumps and rubella vaccine (MMR) 12 to 13 months old – Pneumococcal (PCV) vaccine (3rd dose) 12 to 13 months old – Flu vaccine (annual) 2, 3 and 4 years – Measles, mumps and rubella vaccine (MMR) (2nd dose) 3 years and 4 – months, or soon after 4-in-1 (DTaP/IPV) pre-school booster 3 and 4 months, or soon – after HPV vaccine (girls only) 12 to 13 years old – HPV vaccine (2nd dose, only) 12 to 13 years old – Meningitis C booster 13 to 15 years old – 3-in-1 (Td/IPV) teenage booster 13 to 18 years old – Meningitis C vaccine for students 18-25 years old – Please give details of any illnesses, accidents, hospital admissions, investigations or operations your child has had: Date: Date: Date: Date: Date: Date: Other ongoing health problems: If your child has not had the MMR vaccines as per the schedule above, has your child been vaccinated against measles with a full course of measles vaccines or has your child had the measles virus? Please give details: Does your child follow any special diet (eg, low sugar, weight reducing)? Does your have any allergies? If yes, please give details: MEDICATION Does your child take any regular medication? Y N If yes, please state name, dose and number of times per day Is your child allergic to any medicines? Y N
5-in-1 (DTaP/IPV/Hib) vaccine – 2 months old Pneumococcal (PCV) vaccine – 2 months old Rotavirus vaccine – 2 months old 5-in-1 (DTaP/IPV/Hib) vaccine (2nd dose) – 3 months old Meningitis C – 3 months old Rotavirus vaccine (2nd dose) – 3 months old 5-in-1 (DTaP/IPV/Hib) vaccine (3rd dose) – 4 months old Pneumococcal (PCV) vaccine (2nd dose) – 4 months old Hib/Men C booster – 12 to 13 months old Measles, mumps and rubella vaccine (MMR) – 12 to 13 months old Pneumococcal (PCV) vaccine (3rd dose) – 12 to 13 months old Flu vaccine (annual) – 2, 3 and 4 years Measles, mumps and rubella vaccine (MMR) (2nd dose) – 3 years and 4 months, or soon after 4-in-1 (DTaP/IPV) pre-school booster – 3 and 4 months, or soon after HPV vaccine (girls only) – 12 to 13 years old HPV vaccine (2nd dose, only) – 12 to 13 years old Meningitis C booster – 13 to 15 years old 3-in-1 (Td/IPV) teenage booster – 13 to 18 years old Meningitis C vaccine for students – 18-25 years old Please give details of any illnesses, accidents, hospital admissions, investigations or operations your child has had: Date: Date: Date: Date: Date: Date: Other ongoing health problems: If your child has not had the MMR vaccines as per the schedule above, has your child been vaccinated against measles with a full course of measles vaccines or has your child had the measles virus? Please give details: Does your child follow any special diet (eg, low sugar, weight reducing)? Does your have any allergies? If yes, please give details: MEDICATION Does your child take any regular medication? Y N If yes, please state name, dose and number of times per day Is your child allergic to any medicines? Y N