diff --git a/app/components/app_patient_session_record_component.rb b/app/components/app_patient_session_record_component.rb
index 33c1f94760..6322d761d1 100644
--- a/app/components/app_patient_session_record_component.rb
+++ b/app/components/app_patient_session_record_component.rb
@@ -22,7 +22,7 @@ def render?
       (
         patient_session.registration_status&.attending? ||
           patient_session.registration_status&.completed? ||
-          !patient_session.session.requires_registration?
+          !session.requires_registration?
       )
   end
 
@@ -35,8 +35,14 @@ def render?
 
   def default_vaccinate_form
     pre_screening_confirmed = patient.pre_screenings.today.exists?(programme:)
+    session_date = session.session_dates.today.first
 
-    VaccinateForm.new(patient_session:, programme:, pre_screening_confirmed:)
+    VaccinateForm.new(
+      patient:,
+      session_date:,
+      programme:,
+      pre_screening_confirmed:
+    )
   end
 
   def heading
diff --git a/app/components/app_vaccinate_form_component.rb b/app/components/app_vaccinate_form_component.rb
index 8426b39792..06dc19a26c 100644
--- a/app/components/app_vaccinate_form_component.rb
+++ b/app/components/app_vaccinate_form_component.rb
@@ -11,8 +11,7 @@ def initialize(vaccinate_form)
 
   attr_reader :vaccinate_form
 
-  delegate :patient_session, :programme, to: :vaccinate_form
-  delegate :patient, :session, to: :patient_session
+  delegate :patient, :session, :programme, to: :vaccinate_form
   delegate :academic_year, to: :session
 
   def url
diff --git a/app/controllers/api/testing/teams_controller.rb b/app/controllers/api/testing/teams_controller.rb
index a330d973f6..a1625f7812 100644
--- a/app/controllers/api/testing/teams_controller.rb
+++ b/app/controllers/api/testing/teams_controller.rb
@@ -27,11 +27,7 @@ def destroy
 
         patient_ids = team.patients.pluck(:id)
 
-        patient_sessions = PatientSession.where(session: sessions)
-        log_destroy(PreScreening.where(patient_session: patient_sessions))
-        patient_sessions.in_batches { log_destroy(it) }
-
-        log_destroy(SessionDate.where(session: sessions))
+        log_destroy(PatientSession.where(session: sessions))
 
         log_destroy(AccessLogEntry.where(patient_id: patient_ids))
         log_destroy(ArchiveReason.where(patient_id: patient_ids))
@@ -41,11 +37,14 @@ def destroy
         # In local dev we can end up with NotifyLogEntries without a patient
         log_destroy(NotifyLogEntry.where(patient_id: nil))
         log_destroy(NotifyLogEntry.where(patient_id: patient_ids))
+        log_destroy(PreScreening.where(patient_id: patient_ids))
         log_destroy(SchoolMove.where(patient_id: patient_ids))
         log_destroy(SchoolMove.where(team:))
         log_destroy(SchoolMoveLogEntry.where(patient_id: patient_ids))
         log_destroy(VaccinationRecord.where(patient_id: patient_ids))
 
+        log_destroy(SessionDate.where(session: sessions))
+
         log_destroy(ConsentForm.where(team:))
         log_destroy(Consent.where(team:))
         log_destroy(Triage.where(team:))
diff --git a/app/controllers/patient_sessions/base_controller.rb b/app/controllers/patient_sessions/base_controller.rb
index 8a3614bc56..f67917208b 100644
--- a/app/controllers/patient_sessions/base_controller.rb
+++ b/app/controllers/patient_sessions/base_controller.rb
@@ -19,6 +19,10 @@ def set_session
       )
   end
 
+  def set_session_date
+    @session_date = @session.session_dates.find_by!(value: Date.current)
+  end
+
   def set_academic_year
     @academic_year = @session.academic_year
   end
diff --git a/app/controllers/patient_sessions/session_attendances_controller.rb b/app/controllers/patient_sessions/session_attendances_controller.rb
index 18965d87cd..9f2c762d33 100644
--- a/app/controllers/patient_sessions/session_attendances_controller.rb
+++ b/app/controllers/patient_sessions/session_attendances_controller.rb
@@ -41,10 +41,6 @@ def update
 
   private
 
-  def set_session_date
-    @session_date = @session.session_dates.find_by!(value: Date.current)
-  end
-
   def set_session_attendance
     @session_attendance =
       authorize @patient_session
diff --git a/app/controllers/patient_sessions/vaccinations_controller.rb b/app/controllers/patient_sessions/vaccinations_controller.rb
index 03c173c2ed..72a9b2268c 100644
--- a/app/controllers/patient_sessions/vaccinations_controller.rb
+++ b/app/controllers/patient_sessions/vaccinations_controller.rb
@@ -5,6 +5,7 @@ class PatientSessions::VaccinationsController < PatientSessions::BaseController
   include VaccinationMailerConcern
 
   before_action :set_todays_batch
+  before_action :set_session_date
 
   after_action :verify_authorized
 
@@ -17,7 +18,8 @@ def create
     @vaccinate_form =
       VaccinateForm.new(
         current_user:,
-        patient_session: @patient_session,
+        patient: @patient,
+        session_date: @session_date,
         programme: @programme,
         todays_batch: @todays_batch,
         **vaccinate_form_params
diff --git a/app/forms/vaccinate_form.rb b/app/forms/vaccinate_form.rb
index 3c08ef1267..c354de203b 100644
--- a/app/forms/vaccinate_form.rb
+++ b/app/forms/vaccinate_form.rb
@@ -4,7 +4,13 @@ class VaccinateForm
   include ActiveModel::Model
   include ActiveModel::Attributes
 
-  attr_accessor :patient_session, :programme, :current_user, :todays_batch
+  attr_accessor :patient,
+                :session_date,
+                :programme,
+                :current_user,
+                :todays_batch
+
+  delegate :session, to: :session_date
 
   attribute :identity_check_confirmed_by_other_name, :string
   attribute :identity_check_confirmed_by_other_relationship, :string
@@ -90,19 +96,19 @@ def save(draft_vaccination_record:)
       identity_check_confirmed_by_patient
     draft_vaccination_record.location_id =
       session.location_id unless session.generic_clinic?
-    draft_vaccination_record.patient_id = patient_session.patient_id
+    draft_vaccination_record.patient_id = patient.id
     draft_vaccination_record.performed_at = Time.current
     draft_vaccination_record.performed_by_user = current_user
     draft_vaccination_record.performed_ods_code = organisation.ods_code
     draft_vaccination_record.programme = programme
-    draft_vaccination_record.session_id = patient_session.session_id
+    draft_vaccination_record.session_id = session.id
 
     draft_vaccination_record.save # rubocop:disable Rails/SaveBang
   end
 
   private
 
-  delegate :organisation, :session, to: :patient_session
+  delegate :organisation, to: :session
 
   def administered? = vaccine_method != "none"
 
@@ -131,10 +137,11 @@ def delivery_method
 
   def pre_screening
     @pre_screening ||=
-      patient_session.pre_screenings.build(
+      patient.pre_screenings.build(
         notes: pre_screening_notes,
         performed_by: current_user,
-        programme:
+        programme:,
+        session_date:
       )
   end
 end
diff --git a/app/lib/patient_merger.rb b/app/lib/patient_merger.rb
index 1c7ae387c9..2d054a5bb6 100644
--- a/app/lib/patient_merger.rb
+++ b/app/lib/patient_merger.rb
@@ -40,6 +40,10 @@ def call
         patient_id: patient_to_keep.id
       )
 
+      patient_to_destroy.pre_screenings.update_all(
+        patient_id: patient_to_keep.id
+      )
+
       patient_to_destroy.school_moves.find_each do |school_move|
         if patient_to_keep.school_moves.exists?(
              home_educated: school_move.home_educated,
@@ -78,18 +82,12 @@ def call
       end
 
       patient_to_destroy.patient_sessions.each do |patient_session|
-        if (
-             existing_patient_session =
-               patient_to_keep.patient_sessions.find_by(
-                 session_id: patient_session.session_id
-               )
+        if patient_to_keep.patient_sessions.exists?(
+             session_id: patient_session.session_id
            )
-          patient_session.pre_screenings.update_all(
-            patient_session_id: existing_patient_session.id
-          )
-        else
-          patient_session.update!(patient: patient_to_keep)
+          next
         end
+        patient_session.update!(patient: patient_to_keep)
       end
 
       PatientSession.where(patient: patient_to_destroy).destroy_all
diff --git a/app/models/patient.rb b/app/models/patient.rb
index 835427976b..eac95b4e5b 100644
--- a/app/models/patient.rb
+++ b/app/models/patient.rb
@@ -70,6 +70,7 @@ class Patient < ApplicationRecord
   has_many :parent_relationships, -> { order(:created_at) }
   has_many :patient_sessions
   has_many :pds_search_results
+  has_many :pre_screenings
   has_many :school_move_log_entries
   has_many :school_moves
   has_many :session_notifications
@@ -81,7 +82,6 @@ class Patient < ApplicationRecord
   has_many :gillick_assessments
   has_many :parents, through: :parent_relationships
   has_many :patient_specific_directions
-  has_many :pre_screenings, through: :patient_sessions
   has_many :session_attendances, through: :patient_sessions
   has_many :sessions, through: :patient_sessions
   has_many :teams, -> { distinct }, through: :sessions
diff --git a/app/models/patient_session.rb b/app/models/patient_session.rb
index 712b37fa50..15f6339b2f 100644
--- a/app/models/patient_session.rb
+++ b/app/models/patient_session.rb
@@ -44,7 +44,6 @@ class PatientSession < ApplicationRecord
   belongs_to :patient
   belongs_to :session
 
-  has_many :pre_screenings
   has_many :session_attendances, dependent: :destroy
   has_one :registration_status
 
@@ -64,6 +63,10 @@ class PatientSession < ApplicationRecord
           through: :patient,
           source: :notes
 
+  has_many :pre_screenings,
+           -> { where(patient_id: it.patient_id) },
+           through: :session
+
   has_many :session_notifications,
            -> { where(session_id: it.session_id) },
            through: :patient
diff --git a/app/models/pre_screening.rb b/app/models/pre_screening.rb
index e6efc5a290..7c735542c2 100644
--- a/app/models/pre_screening.rb
+++ b/app/models/pre_screening.rb
@@ -8,34 +8,36 @@
 #  notes                :text             default(""), not null
 #  created_at           :datetime         not null
 #  updated_at           :datetime         not null
-#  patient_session_id   :bigint           not null
+#  patient_id           :bigint           not null
 #  performed_by_user_id :bigint           not null
 #  programme_id         :bigint           not null
+#  session_date_id      :bigint           not null
 #
 # Indexes
 #
-#  index_pre_screenings_on_patient_session_id    (patient_session_id)
+#  index_pre_screenings_on_patient_id            (patient_id)
 #  index_pre_screenings_on_performed_by_user_id  (performed_by_user_id)
 #  index_pre_screenings_on_programme_id          (programme_id)
+#  index_pre_screenings_on_session_date_id       (session_date_id)
 #
 # Foreign Keys
 #
-#  fk_rails_...  (patient_session_id => patient_sessions.id)
+#  fk_rails_...  (patient_id => patients.id)
 #  fk_rails_...  (performed_by_user_id => users.id)
 #  fk_rails_...  (programme_id => programmes.id)
+#  fk_rails_...  (session_date_id => session_dates.id)
 #
 class PreScreening < ApplicationRecord
-  audited associated_with: :patient_session
+  audited associated_with: :patient
 
-  belongs_to :patient_session
+  belongs_to :patient
+  belongs_to :session_date
   belongs_to :programme
   belongs_to :performed_by,
              class_name: "User",
              foreign_key: :performed_by_user_id
 
-  has_one :patient, through: :patient_session
-
-  scope :today, -> { where(created_at: Date.current.all_day) }
+  scope :today, -> { joins(:session_date).merge(SessionDate.today) }
 
   encrypts :notes
 
diff --git a/app/models/session.rb b/app/models/session.rb
index 1d7031bf8e..765452bed1 100644
--- a/app/models/session.rb
+++ b/app/models/session.rb
@@ -51,6 +51,7 @@ class Session < ApplicationRecord
 
   has_one :organisation, through: :team
   has_one :subteam, through: :location
+  has_many :pre_screenings, through: :session_dates
   has_many :programmes, through: :session_programmes
   has_many :gillick_assessments, through: :session_dates
   has_many :patients, through: :patient_sessions
diff --git a/app/models/session_date.rb b/app/models/session_date.rb
index ef617f17d7..1e366eaaae 100644
--- a/app/models/session_date.rb
+++ b/app/models/session_date.rb
@@ -22,6 +22,7 @@ class SessionDate < ApplicationRecord
   belongs_to :session
 
   has_many :gillick_assessments, dependent: :restrict_with_error
+  has_many :pre_screenings, dependent: :restrict_with_error
   has_many :session_attendances, dependent: :restrict_with_error
 
   scope :for_session, -> { where("session_id = sessions.id") }
@@ -44,7 +45,7 @@ def today_or_past? = today? || past?
   def today_or_future? = today? || future?
 
   def has_been_attended?
-    gillick_assessments.any? || session_attendances.any?
+    gillick_assessments.any? || pre_screenings.any? || session_attendances.any?
   end
 
   private
diff --git a/db/migrate/20250821124416_remove_patient_session_from_pre_screenings.rb b/db/migrate/20250821124416_remove_patient_session_from_pre_screenings.rb
new file mode 100644
index 0000000000..5a1813b755
--- /dev/null
+++ b/db/migrate/20250821124416_remove_patient_session_from_pre_screenings.rb
@@ -0,0 +1,47 @@
+# frozen_string_literal: true
+
+class RemovePatientSessionFromPreScreenings < ActiveRecord::Migration[8.0]
+  def up
+    change_table :pre_screenings, bulk: true do |t|
+      t.references :patient, foreign_key: true
+      t.references :session_date, foreign_key: true
+    end
+
+    PreScreening.find_each do |pre_screening|
+      patient_session = PatientSession.find(pre_screening.patient_session_id)
+      patient_id = patient_session.patient_id
+      session_id = patient_session.session_id
+      session_date_id =
+        SessionDate.find_by!(
+          session_id:,
+          value: pre_screening.created_at.to_date
+        )
+      pre_screening.update_columns(patient_id:, session_date_id:)
+    end
+
+    change_table :pre_screenings, bulk: true do |t|
+      t.change_null :patient_id, false
+      t.change_null :session_date_id, false
+      t.remove_references :patient_session
+    end
+  end
+
+  def down
+    add_reference :pre_screenings, :patient_session
+
+    PreScreening.find_each do |pre_screening|
+      session_id = SessionDate.find(pre_screening.session_date_id).session_id
+      patient_session =
+        PatientSession.find_by!(
+          patient_id: pre_screening.patient_id,
+          session_id:
+        )
+      pre_screening.update_column(:patient_session_id, patient_session.id)
+    end
+
+    change_table :pre_screenings, bulk: true do |t|
+      t.change_null :patient_session_id, false
+      t.remove_references :patient, :session_date
+    end
+  end
+end
diff --git a/db/schema.rb b/db/schema.rb
index d4cd8a8ec5..7673f8b546 100644
--- a/db/schema.rb
+++ b/db/schema.rb
@@ -722,15 +722,17 @@
   end
 
   create_table "pre_screenings", force: :cascade do |t|
-    t.bigint "patient_session_id", null: false
     t.bigint "performed_by_user_id", null: false
     t.text "notes", default: "", null: false
     t.datetime "created_at", null: false
     t.datetime "updated_at", null: false
     t.bigint "programme_id", null: false
-    t.index ["patient_session_id"], name: "index_pre_screenings_on_patient_session_id"
+    t.bigint "patient_id", null: false
+    t.bigint "session_date_id", null: false
+    t.index ["patient_id"], name: "index_pre_screenings_on_patient_id"
     t.index ["performed_by_user_id"], name: "index_pre_screenings_on_performed_by_user_id"
     t.index ["programme_id"], name: "index_pre_screenings_on_programme_id"
+    t.index ["session_date_id"], name: "index_pre_screenings_on_session_date_id"
   end
 
   create_table "programmes", force: :cascade do |t|
@@ -1072,8 +1074,9 @@
   add_foreign_key "patients", "locations", column: "gp_practice_id"
   add_foreign_key "patients", "locations", column: "school_id"
   add_foreign_key "pds_search_results", "patients"
-  add_foreign_key "pre_screenings", "patient_sessions"
+  add_foreign_key "pre_screenings", "patients"
   add_foreign_key "pre_screenings", "programmes"
+  add_foreign_key "pre_screenings", "session_dates"
   add_foreign_key "pre_screenings", "users", column: "performed_by_user_id"
   add_foreign_key "reporting_api_one_time_tokens", "users"
   add_foreign_key "school_move_log_entries", "locations", column: "school_id"
diff --git a/spec/components/app_activity_log_component_spec.rb b/spec/components/app_activity_log_component_spec.rb
index 24d0d5bb59..85da16d3df 100644
--- a/spec/components/app_activity_log_component_spec.rb
+++ b/spec/components/app_activity_log_component_spec.rb
@@ -483,7 +483,8 @@
       create(
         :pre_screening,
         performed_by: user,
-        patient_session:,
+        patient:,
+        session: patient_session.session,
         notes: "Some notes",
         created_at: Time.zone.local(2025, 6, 1, 12)
       )
diff --git a/spec/components/app_vaccinate_form_component_spec.rb b/spec/components/app_vaccinate_form_component_spec.rb
index 946549d72b..40ef233d3a 100644
--- a/spec/components/app_vaccinate_form_component_spec.rb
+++ b/spec/components/app_vaccinate_form_component_spec.rb
@@ -6,6 +6,7 @@
   let(:programme) { create(:programme) }
   let(:programmes) { [programme] }
   let(:session) { create(:session, :today, programmes:) }
+  let(:session_date) { session.session_dates.first }
   let(:patient) do
     create(
       :patient,
@@ -18,7 +19,9 @@
     create(:patient_session, :in_attendance, programmes:, patient:, session:)
   end
 
-  let(:vaccinate_form) { VaccinateForm.new(patient_session:, programme:) }
+  let(:vaccinate_form) do
+    VaccinateForm.new(patient:, session_date:, programme:)
+  end
 
   let(:component) { described_class.new(vaccinate_form) }
 
diff --git a/spec/controllers/api/testing/teams_controller_spec.rb b/spec/controllers/api/testing/teams_controller_spec.rb
index 5935538b82..67c1bdc75e 100644
--- a/spec/controllers/api/testing/teams_controller_spec.rb
+++ b/spec/controllers/api/testing/teams_controller_spec.rb
@@ -71,7 +71,7 @@
 
       create(:school_move, :to_school, patient: Patient.first)
       create(:session_date, session: Session.first)
-      create(:pre_screening, patient_session: PatientSession.first)
+      create(:pre_screening, patient: Patient.first, session: Session.first)
     end
 
     it "deletes associated data" do
diff --git a/spec/factories/pre_screenings.rb b/spec/factories/pre_screenings.rb
index 4b7b4d3d7d..5ea885a108 100644
--- a/spec/factories/pre_screenings.rb
+++ b/spec/factories/pre_screenings.rb
@@ -8,27 +8,34 @@
 #  notes                :text             default(""), not null
 #  created_at           :datetime         not null
 #  updated_at           :datetime         not null
-#  patient_session_id   :bigint           not null
+#  patient_id           :bigint           not null
 #  performed_by_user_id :bigint           not null
 #  programme_id         :bigint           not null
+#  session_date_id      :bigint           not null
 #
 # Indexes
 #
-#  index_pre_screenings_on_patient_session_id    (patient_session_id)
+#  index_pre_screenings_on_patient_id            (patient_id)
 #  index_pre_screenings_on_performed_by_user_id  (performed_by_user_id)
 #  index_pre_screenings_on_programme_id          (programme_id)
+#  index_pre_screenings_on_session_date_id       (session_date_id)
 #
 # Foreign Keys
 #
-#  fk_rails_...  (patient_session_id => patient_sessions.id)
+#  fk_rails_...  (patient_id => patients.id)
 #  fk_rails_...  (performed_by_user_id => users.id)
 #  fk_rails_...  (programme_id => programmes.id)
+#  fk_rails_...  (session_date_id => session_dates.id)
 #
 FactoryBot.define do
   factory :pre_screening do
-    patient_session
-    programme { patient_session.programmes.first }
+    transient { session { association(:session) } }
+
+    patient
+    session_date { session.session_dates.first }
+    programme { session_date.session.programmes.first }
     performed_by
+
     notes { "Fine to vaccinate" }
   end
 end
diff --git a/spec/lib/patient_merger_spec.rb b/spec/lib/patient_merger_spec.rb
index b8791ea848..22e3d41a98 100644
--- a/spec/lib/patient_merger_spec.rb
+++ b/spec/lib/patient_merger_spec.rb
@@ -57,7 +57,7 @@
     let(:patient_session) do
       create(:patient_session, session:, patient: patient_to_destroy)
     end
-    let(:pre_screening) { create(:pre_screening, patient_session:) }
+    let(:pre_screening) { create(:pre_screening, patient: patient_to_destroy) }
     let(:school_move) do
       create(:school_move, :to_school, patient: patient_to_destroy)
     end
diff --git a/spec/models/pre_screening_spec.rb b/spec/models/pre_screening_spec.rb
index d75e2f0ffd..82c6c812e2 100644
--- a/spec/models/pre_screening_spec.rb
+++ b/spec/models/pre_screening_spec.rb
@@ -8,25 +8,34 @@
 #  notes                :text             default(""), not null
 #  created_at           :datetime         not null
 #  updated_at           :datetime         not null
-#  patient_session_id   :bigint           not null
+#  patient_id           :bigint           not null
 #  performed_by_user_id :bigint           not null
 #  programme_id         :bigint           not null
+#  session_date_id      :bigint           not null
 #
 # Indexes
 #
-#  index_pre_screenings_on_patient_session_id    (patient_session_id)
+#  index_pre_screenings_on_patient_id            (patient_id)
 #  index_pre_screenings_on_performed_by_user_id  (performed_by_user_id)
 #  index_pre_screenings_on_programme_id          (programme_id)
+#  index_pre_screenings_on_session_date_id       (session_date_id)
 #
 # Foreign Keys
 #
-#  fk_rails_...  (patient_session_id => patient_sessions.id)
+#  fk_rails_...  (patient_id => patients.id)
 #  fk_rails_...  (performed_by_user_id => users.id)
 #  fk_rails_...  (programme_id => programmes.id)
+#  fk_rails_...  (session_date_id => session_dates.id)
 #
 describe PreScreening do
   subject(:pre_screening) { build(:pre_screening) }
 
+  describe "associations" do
+    it { should belong_to(:patient) }
+    it { should belong_to(:session_date) }
+    it { should belong_to(:programme) }
+  end
+
   describe "scopes" do
     describe "#today" do
       subject { described_class.today }
@@ -37,8 +46,9 @@
         it { should include(pre_screening) }
       end
 
-      context "with an instance created yesterday" do
-        let(:pre_screening) { create(:pre_screening, created_at: 1.day.ago) }
+      context "with an instance for yesterday" do
+        let(:session_date) { create(:session_date, value: Date.yesterday) }
+        let(:pre_screening) { create(:pre_screening, session_date:) }
 
         it { should_not include(pre_screening) }
       end
diff --git a/spec/models/session_date_spec.rb b/spec/models/session_date_spec.rb
index 0149ee04a1..70bc81bab2 100644
--- a/spec/models/session_date_spec.rb
+++ b/spec/models/session_date_spec.rb
@@ -66,6 +66,12 @@
       it { should be(true) }
     end
 
+    context "with a pre-screening" do
+      before { create(:pre_screening, session:) }
+
+      it { should be(true) }
+    end
+
     context "with a session attendance" do
       before do
         create(