Travel Risk Assessment

Please note this is not an urgent medical service. It may take up to 3 weeks for your needs to be assessed during busy periods so please ensure that you submit your form in good time.

If you are travelling abroad please make sure you contact us at least 6 weeks ahead of your travel plans, 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.

Travel Risk Assessment

Please use this date format: DD/MM/YYYY
Holiday type:
Type of trip:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Catering:

Please read the following Travel Health Advice.

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Including diabetes, heart or lung conditions
Have you ever had a serious reaction to a vaccine given to you before?
Does having an injection make you feel faint?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Have you ever had any of the following vaccinations / malaria tablets?

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

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