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Occupational Health form

Please note: all prices are inclusive of appointment costs and VAT will be added where relevant to non-member practices.

Vaccinations

Please choose which services you require from the following options:

Tetanus/Polio/Diphtheria DTP (single booster) – £32.64
Tetanus/Polio/Diphtheria DTP (single dose) – £32.64
Hepatitis B (single dose – 3 doses required) – £33.80
Varicella Imms (2 doses) – price on request
MMR vaccine (up to 2 doses) – £32.44
MMR vaccine (booster dose) – £100
MMR vaccine (full course) – £200

Pathology

Please choose which services you require from the following options:

TB Quantiferon gold – £82.59
Hepatitis B Immunity – £30.42
Hepatitis B Screen – £30.42
Varicella Immunity – £30.42
Rubella Immunity – £30.42
Measles Immunity – £30.42
Hepatitis C Screen – £30.42
BCG Scar Check – £8.51
HIV Antibody Screen – £30.42

Declaration *

By ticking this box, you confirm that you agree to cover the cost of the employee’s treatments listed above. Please note: if the employee does not attend the booked appointment, an appointment fee of £12.50 will be charged. If the employee cancels with 24 hours of the appointment, you will also be charged the appointment fee.

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Date *

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Registered address: Alliance for Better Care CIC, Horley Health Hub, 120 Victoria Road, Horley, RH6 7BL. Registered company number 09329846. Registered VAT no: 410852622.

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