Travel Risk Assessment Form

Please complete the form below and then arrange for two consecutive appointments (i.e. two appointments together) with one of our practice nurses; you can book your appointments on the next page after submitting your form. We recommend that this is done at least 8 weeks before you leave for your holiday. Our Travel Advice page is filled with useful information if you are planning to travel outside of the UK.  For registered patients only.

Travel risk assessment form
Please use this date format: DD/MM/YYYY
Please write your name. For discussion when risk assessment is performed within your appointment. I have no reason to think that I might be pregnant. I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to ask questions. I consent to the vaccines being given. I confirm that I have read and understood the Travel Advice.
Please use this date format: DD/MM/YYYY