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.

Travel Questionnaire

Travel Questionnaire

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.
(For Malaria Treatment)
Are You Stopping On The Journey
Do you have any medical problems?
Do they require supervision?
Are you taking steroids?
Are you on regular medicine?
What are you staying in?
Are you pregnant?
Check the box if you have been immunised against:
Have you reacted badly to any previous vaccine?
Are you allergic to any medicine?