Travel Risk Assessment

Please note that each person travelling whether an adult or a child will each need to complete an individual form to enable us to process the forms correctly.

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.

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 use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
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.

Vaccines

Payment must be made at time of appointment, we accept cash and debit card payments only.