Travel Risk Assessment

Are you going on holiday? Want to know if you are up-to-date with your immunisations?

Please call the Practice on 01242 215000 to make a phone call appointment with a Nurse to discuss. Before the appointment please check to see what immunisations you may need from suitable websites like Nathnac or Travax.

If you need any vaccinations the Nurse will make a follow-up appointment with you. Please note only vaccines provided by the NHS will be offered e.g. Tetanus, Typhoid Hep A. Private vaccinations or prescriptions will not be provided by the Practice e.g. Malaria tablets.

Please note if you are seeking advice less than 6 weeks before you travel or you will be visiting multiple countries you will need to contact a private travel vaccination clinic or a pharmacy offering travel healthcare services.

Travel Risk Assessment

Travel Risk Assessment

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):

*