Travel Risk Assessment

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All questions marked with a * are mandatory

Please complete this form and ensure you have uploaded any previous immunisation records that may not be on your records.

We will review and contact you with advice- if NHS vaccines are needed we will advise you book a travel clinic appointment with our nurse. Due to high demand these are limited to ensure enough capacity is available for other essential nursing services.

I have uploaded past immunisation data: *

I have no relevant data available: *

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Personal Details

Please double check you've entered the correct email address

May be used to identify you

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Dates and Trip Details

If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.

Similarly, Typhoid if needed is recommended if it has been more than 3 years since your last vaccination.

Please review the precautions advised on the TavelhealthPro website.

After reviewing Travelheathpro, please confirm which NHS vaccines you believe you may require: *

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Personal Medical History

Have you ever had a serious reaction to a vaccine given to you before?: *

Have you recently undergone radiotherapy, chemotherapy or steroid treatment?: *

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Signed & Dated

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Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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