Travel Vaccination Enquiry

Assess what you will need for travel by visiting NHS Travel health, TravelHealthPro or Fit for Travel.

Please complete the form at least 8 weeks before you travel, the Nurse will process the form and the outcome will be available after 5 working days, please call the surgery to book any necessary appointments.

Travel Vaccination Enquiry

Travel Vaccination Enquiry


Details of Travel

Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY

Type of Travel

Holiday type:
Type of trip:
Staying in area which is:
Planned activities:

Medical History

Do you have any allergies or a vaccine allergy?
Do you faint or feel faint with injections?
Have you ever suffered from anxiety or depression?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Including diabetes, heart or lung conditions

It is essential that you allow adequate time to have the immunisations for your trip. If there is not sufficient time to offer an appointment at the practice, you may be asked to go to a Private Health Clinic. We would recommend that you take out travel insurance for your trip.

I understand and agree to the above terms regarding notice of intended travel, availability of appointments and costs that I may be liable to pay.