Travel Risk Assessment

Please note, due to the current ongoing situation with Coronavirus, we will be limiting all routine appointments for the foreseeable. Please therefore think carefully about the urgency of your enquiry before proceeding.

If you are travelling abroad you will need to start thinking about your travel vaccinations at least 6 weeks before you’re due to leave as some vaccinations can take time to become effective.

To help the Travel Nurses assess your travel needs it is important that they are in receipt of the assessment form before your appointment.

You must be registered with this practice to submit this form. 

Travel Risk Assessment

Travel Risk Assessment

Please use this date format: DD/MM/YYYY.
Gender:
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Type of trip:
Holiday type:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Have you ever had a serious reaction to a vaccine given to you before?
Does having an injection make you feel faint?
Do you or any close family members have epilepsy?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Have you ever had any of the following vaccinations / malaria tablets (if known)?
(no label) *