• Travel Questionnaire

  • If you are planning to travel outside the UK, you may need to be vaccinated against some serious diseases found in other parts of the world.

    If you are planning to travel abroad and would like to know what if any vaccinations are advised for your trip please complete our travel vaccination form, at least 8-weeks before you travel, this is important as some vaccinations require a course of multiple vaccinations that are started at least six weeks before you travel.

    Some travel vaccines are ordered on a private prescription, and these incur a charge over and above the normal prescription charge. This is because not all travel vaccinations are included in the services provided by the NHS.

    You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

    Travel Health Pro

    NHS Fit for Travel

    Some countries will require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

    In order for our team to be able to provide you with the most appropriate travel advice, please fill out the online form below. Once this form has been completed our team will aim to be in contact with you to advise on recommended travel vaccinations within five working days,

    Please be aware that whilst you are abroad the surgery will not be able to:

    Provide any medical advice by phone, or email
    Provide any copies of your prescriptions should you run out of any of your medications or ensure that there are suitable medication supplies at your intended destination if you leave any of your medication at home.
    Source a doctor or medical assistance for you.

  • Personal Details
  • Trip Dates
  • Itinerary
  • Trip Description - please tick all appropriate boxes:
  • Vaccine History

    Have you ever had any of the following vaccinations / tablets and if so, when?
  • Should be Empty: