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.

Completion of this form will not guarantee an appointment as appointment availability for travel is limited. Patients may be directed to a private travel clinic.

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.

Travel Risk Assessment

Section

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):