Travel Risk Assessment

  • We like to have 8 weeks notice prior to your trip (longer if complicated itinerary). Please complete this form and call reception a week later.
  • Between 3 & 8 weeks, complete this form and phone 5 working days later to see if a suitable appointment can be found. If an appointment can’t be found please ask reception to print off a list of your vaccines to take to a travel clinic. Appointments will only be fitted in if possible.
  • Less than 3 weeks do not complete this form as you will need to go to a travel clinic for your consultation. Please ask reception to print details of previous vaccines to take with you.

Please complete a separate travel risk assessment for each person travelling who is registered at the practice. We cannot respond to multiple travellers on one form.

Thank you for your co-operation.

Travel Risk Assessment

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Including diabetes, heart or lung conditions

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