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.

Any vaccines that are not provided on the NHS will need to be obtained from the private travel clinics. In order to obtain advice regarding any other vaccinations and malaria prophylaxis recommended and other precautions needed whilst travelling abroad and not provided by us, we suggest you request an appointment with one of the private travel clinics listed below:

Note: You will be charged for services provided by these clinics.

You will need to take a printed copy of your vaccination history to your travel clinic appointment; this will be provided by the surgery when you attend for your appointment with the nurse.

The following vaccinations are available, free of charge, from the NHS and will be provided by us if recommended:

  • Hepatitis
  • Diptheria/Tetanus/Polio
  • Typhoid
Travel Risk Assessment

Travel Risk Assessment

Section

Sex:
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Holiday type:
Type of trip:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Including diabetes, heart or lung conditions
Have you ever had a serious reaction to a vaccine given to you before?
Does having an injection make you feel faint?
Do you or any close family members have epilepsy?
Do you have any history or mental illness including depression or anxiety?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Have you ever had any of the following vaccinations / malaria tablets?

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

*