Travel Risk Assessment Form

A Travel Vaccine Assessment Form must be completed 6 weeks before travel.  

A form is required per person for each traveller. This includes children under 18.

Non-urgent advice: Please note

Complete only if you are registered at this practice.
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).
Title
Date of Birth
Address
Email
Women Only: Is there any possibility you may be pregnant?
Destination(s)
UK Departure Date
Please enter a number from 0 to 99999.
Further Information
Purpose of your trip
Holiday type
Accommodation
Setting
Planned Activities
Are you fit for travel?
Do you have any allergies?
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