Vitamin B12 Injection > Vitamin B12 Injection Request Vitamin B12 Injection Request EligibilityThis service is available for adults aged 18 years or over.Are you aged 18 or over? Yes, I am aged 18 or over No, I am under 18 ✕ Warning — Cannot Continue You must be 18 or over Vitamin B12 injections are only available for adults aged 18 years or over. Patient DetailsFull Name(Required)Enter your full legal name.Date of Birth(Required) DD slash MM slash YYYY Your date of birth is required to verify you are over 18 and eligible for treatment.Email Address(Required) We will use this email address to send consultation updates and treatment information.Phone Number(Required)A pharmacist may contact you if further clinical review is required.Home Address(Required) Street Address Address Line 2 City Post Code Treatment InformationWhy are you requesting a Vitamin B12 injection?(Required) Low energy / fatigue General wellbeing Previously recommended by a healthcare professional Other Have you received a Vitamin B12 injection before?(Required) Yes No Health CheckDo you have any of the following conditions?(Required) Vitamin B12 deficiency diagnosed by a doctor Anaemia None of the above Do you have any allergies to Vitamin B12, cobalt, or injections?(Required) Yes No Not sure Please list your allergies(Required)Include any known medicine or injection-related allergies. ! Warning — Please Read Allergy review required Your allergy history will be reviewed by the pharmacist before any injection is given. Are you pregnant or breastfeeding?(Required) Yes No Not applicable ! Warning — Please Read Medical review required The pharmacist will review whether this treatment is suitable during pregnancy. Are you currently taking any regular medication?(Required) Yes No This helps identify possible precautions.Please list any regular medication(Required)Appointment RequestPreferred Appointment Date(Required) DD slash MM slash YYYY Select a preferred date to visit the pharmacy.Preferred Time of Day(Required) Morning Afternoon Anytime GP Details and ConsentGP Practice NameEnter the name of your GP surgery if known.GP Practice PostcodeEnter the postcode of your GP surgery if known.Consent to contact my GP if needed(Required) Yes No I consent to the pharmacy contacting my GP practice if needed to support my consultation or treatment review. ! Warning — Please Read GP notification recommended We recommend informing your GP for continuity of care. A clinician may discuss this with you. DeclarationsInformation Accuracy(Required) I confirm my information is accuratePlease ensure all details are correct before submitting.Vitamin B12 Injection Consent(Required) I consent to this consultationI consent to the pharmacy reviewing my information to assess whether a Vitamin B12 injection is appropriate and safe to administer.Privacy Policy(Required) I agree to the Privacy PolicyPlease review how we collect, use and protect your personal data.CAPTCHA What to expect Complete this consultation so our pharmacist can review your request and confirm whether a Vitamin B12 injection is suitable for you.Confirmation email sent after submissionReviewed by our pharmacistAppointment offered if suitable Next steps 1Complete the B12 consultation form 2Check your email for confirmation 3Our pharmacist reviews your request 4We confirm your appointment by email