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Travel risk assessment

Travel Risk Assessment (NEW)

Section

Before completing this form please visit the following website where you will find all the information that you require on the vaccines recommended for your trip: www.travelhealthpro.org.uk

Once you have all the information on the vaccines recommended to you please complete the following form. The Nurse will then check this against your records to confirm whether you are currently protected or require up to date vaccinations. Please note that there are a cost to some vaccines, listed below. Not all of these are compulsory.

Please call the Surgery on 01264 361424, 14 days after handing us your form to arrange an appointment if necessary. Please note it is your responsibility to ensure that you follow up, the Surgery will not prompt you to book this appointment.

Please include postcode
DD/MM/YYYY

In order to give appropriate advice and vaccinations, it is necessary for you to answer the following questions:
All information given is strictly confidential.
Is your period late?
Are you pregnant?
Are you taking steroids?
Are you allergic to antibiotics?
Are you having chemo/radiotherapy?
Do you suffer a form of AIDS or at risk of HIV?
Are you unwell at present?
Do you have any allergies e.g. egg?

Vaccines

Revaxis (Diptheria, Tetanus & Polio) Free
Hepatitis A (course of 2) Free
Typhoid Free
Hepatitis B (course of 3) £120
Hepatitis B Booster £50
Yellow Fever (including certificate) £70
Meningitis ACWY £40
Rabies (course of 3) £210
Maleria Advice Free
Maleria (Private Prescription) N.B. Chemist will also charge per tablet. £20
Payment must be made at time of appointment, we accept cash and debit card payments only.