Travel Questionnaire

If you require any vaccinations relating to foreign travel you will need to fill out a travel questionnaire, please ask reception for a form or click on the link below for a printable version. This will include which countries and areas within countries that you are visiting enable our Nursing team to determine what vaccinations are required.

It is important that you complete the questionnaire and return it to us at least 6 weeks before you travel. The nurses will then look at your medical records and the national guidelines to determine what vaccinations you will need. Please note that these vaccines have to be ordered as they are not stock vaccines. Your appointment with the nurse for the actual vaccinations needs to be at least 2 weeks before you travel to allow the vaccines to work.

Some travel vaccines are not able to be provided by our nurses. This is because not all travel vaccinations are included in the services provided by the NHS. If this is the case we will let you know and give you the details of local private travel clinics.

If you are travelling in less than 6 weeks please contact one of the following 

Travel Questionnaire

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).
Date of Birth
Women Only: Is there any possibility you may be pregnant?
UK Departure Date
Please enter a number from 0 to 99999.
Further Information
Purpose of your trip
Holiday type
Planned Activities
Are you fit for travel?
Do you have any allergies?