Deficiency Vitamin B12
Have you been diagnosed with a Vitamin B12 deficiency?
Having vitamin B12 deficiency means that your body does not have enough of this vitamin. You need B12 to make red blood cells, which carry oxygen through your body. Not having enough B12 can lead to anemia, which means your body does not have enough red blood cells to do the job.

    Yes   No

    Date of birth*
    NHS Number
    GP Surgery

    Church Lane Surgery   Mount Chambers   Blyth's Meadow   Blandford Medical Centre   Great Notley Surgery   Elizabeth Courtauld Surgery   The Pump House Surgery   Other

    Date of diagnosis*
    I have a copy of my last B12 level*
    Date of last injection*
    The cost per dose is £60 (hydroxocobalamin 1mg/1ml)
    *I hereby declare that the above information is correct and give my consent to receiving B12 injection
    *I consent to this information being shared with my GP