Travel Health Questionnaire

Requests for vaccinations require at least 8 weeks’ notice. This is important as some vaccines do not offer adequate protection until up to 14 days after administration and others up to 3 months particularly if you intend to travel for more than 1 month and/or to remote areas.

Please note that we cannot guarantee that requests for vaccinations at short notice will be given by the practice. In these circumstances you may have to contact an alternative provider. Vaccinations that may be given for travel supplied by the NHS include Hepatitis A, Typhoid, Tetanus/diptheria/polio. Any anti-malarial drugs not available for purchase at your pharmacy will be issued on private prescription only which will incur a charge and the cost of the medication is payable to your pharmacy.

Title
Date of Birth
Address
Email
Women Only: Is there any possibility you may be pregnant?
Destination(s)
UK Departure Date
Please enter a number from 0 to 99999.
Further Information
Purpose of your trip
Holiday type
Accommodation
Setting
Planned Activities
Are you fit for travel?
Do you have any allergies?