Travel Risk Assessment

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.

Do you give consent to receiving text messages from the Practice? *

Women Only

Are you pregnant or planning pregnancy? *
Are you breastfeeding? *
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Have you taken out travel insurance? *
If you have a medical condition, have you informed the insurance company about this? *
Including diabetes, heart or lung conditions

Please state which year you had the vaccination(s):