Travel Risk Assessment

If you are travelling abroad please make sure you allow 8 weeks to arrange any vaccinations that may be necessary. To help the Travel nurses assess your travel needs please submit this form.

Our Travel Administrator will contact you via email to advise which travel vaccines are recommended.

Please note we do not offer travel vaccine appointments at St Faiths surgery only Drayton & Horsford Surgeries.

Please read the form below carefully and submit once complete.

Travel Questionaire
Please complete the form below to get more information about what travel immunisations you require.

Most vaccines are given at least 2 weeks before travel, and some more complicated regimes take longer. Please try to give us prior notice (preferably 6 weeks).

Tittle *
Address *
Address
Zip/Postal
City
Country
Is there any possibility you may be pregnant? *
Destination(s)
Further Information
Purpose of your trip *
Holiday Type *
Accommodation *
Setting
Planned Activities
Are you fit for travel? *
Do you have any allergies? *