Travel Risk Assessment

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If you are planning a trip abroad, please visit Travel Health Pro for advice on the vaccinations needed and other useful information.

If vaccinations are recommended, please complete the form below. 

  • The surgery does not provide travel vaccinations for Yellow Fever, Hepatitis B, Rabies, Japanese Encephalitis, or Cholera and will need to be sourced in a travel clinic.
  • Malaria tablets are available from pharmacies.

The form will be assessed by a member of the nursing team and we will be in touch to book an appointment.  Please note that our travel appointments can be booked up several weeks in advance so please allow plenty of time before you travel. 

Personal Details

Please complete this form. We will contact you with the next available appointment. One of our nurses will review your requirements before your appointment and will contact you with any queries.

Please double check you've entered the correct email address
May be used to identify you
Dates and Trip Details
Vaccination Requirements
Personal Medical History
Including diabetes, heart or lung conditions
Signed & Dated

This form is automatically dated upon submission.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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