Travel Risk Assessment

If you are travelling abroad please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. To help the Travel Nurses assess your travel needs it is important that they are in receipt of the assessment form before your appointment.

Please be aware that any replies from the surgery may appear in your Junk Inbox.

Travel Questionaire
Please complete the form below to get more information about what travel immunisations you require.

Most vaccines are given at least 2 weeks before travel, and some more complicated regimes take longer. Please try to give us prior notice (preferably 6 weeks).

Tittle *
Address *
Address
Zip/Postal
City
Country
Is there any possibility you may be pregnant? *
Destination(s)
Further Information
Purpose of your trip *
Holiday Type *
Accommodation *
Setting
Planned Activities
Are you fit for travel? *
Do you have any allergies? *