Travel Risk Assessment

We offer a Travel Consultation Service for our patients, but appointments can only be assured a minimum of six weeks before departure.

A form should be submitted online or can be collected from reception ONLY when an appointment has been made, and a minimum of a week before the date you are to be seen.

Please note, we do not offer the following travel vaccines: Rabies, Japanese Enchephalitis, Tick-bourne encephalitis, Hepatitis B, Meningitis ACWY or Yellow Fever – should you require any of these vaccines you would need to attend a Private Travel Clinic or Chemist.

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
Have you taken out travel insurance for this trip?
Do you plan to travel again in the future?

Please supply details of your personal medical history

Women only

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