Measles, mumps and rubella: surveillance form

Form for health professionals to supply additional patient information after UKHSA has confirmed a case of measles, mumps or rubella.

Applies to England


Measles, mumps and rubella: surveillance form for confirmed cases

Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email Please tell us what format you need. It will help us if you say what assistive technology you use.


Completed forms should either be uploaded to the HPZone record or return them to

Updates to this page

Published 19 August 2014
Last updated 27 October 2023 + show all updates
  1. Updated form.

  2. First published.

Sign up for emails or print this page