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.

Travel Risk Assessment

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY

Third party Consent

Patient MUST sign this section and nominate an individual in order to consent for a Nurse to discuss relevant information with a third party.
I give consent for the above named individual to discuss my medical information regarding my travel requirements.
Including diabetes, heart or lung conditions

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