Travel Risk Assessment

If you are travelling abroad please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. To help the Travel Nurses assess your travel needs it is important that they are in receipt of the assessment form before your appointment.

It is important to make the initial appointment as early as possible – at least 6-10 weeks before you travel – as a second appointment will be required with the practice nurse to actually receive the vaccinations. These vaccines have to be ordered as they are not a stock vaccine. Your second appointment needs to be at least 2 weeks before you travel to allow the vaccines to work.

Please be aware that some vaccination programmes may require up to 3 months for schedules to be completed.

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. This can be confirmed with the practice nurse at the first appointment.

For further information, please see our Travel Room and Travel Fees page.

Travel Risk Assessment

Travel Risk Assessment

Sex:
Please use this date format: DD/MM/YYYY
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Do you plan to travel abroad again in the future?
Holiday type:
Type of trip:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Are you fit and well today?
Do you have any allergies?
Have you ever had a serious reaction to a vaccine given to you before?
Does having an injection make you feel faint?
Any surgical operations in the past, including e.g. your spleen, or thymus gland removed?
Including diabetes, heart or lung conditions
Recent chemotherapy/radiotherapy/organ transplant?
Anaemia?
Bleeding/clotting disorders (including history of DVT)?
Heart disease (e.g. angina, high blood pressure)?
Diabetes?
Disability?
Epilepsy/seizures?
Gastrointestinal (stomach) complaints?
Liver and/or kidney problems?
HIV/AIDS?
Immune system condition?
Mental health issues (including anxiety, depression)?
Neurological (nervous system) illness?
Respiratory (lung) disease?
Rheumatology (joint) conditions?
Spleen problems?
Any other conditions?
Have you ever had any of the following vaccinations / malaria tablets?

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

*