Travel Risk Assessment

This website is not monitored out of surgery hours so patients will not receive any response until service resumes. Please redirect requests to NHS 111 or your local pharmacy out of hours.

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
Please use this date format: DD/MM/YYYY
Have you taken out travel insurance for this trip?
Do you plan to travel again in the future?

Please supply details of your personal medical history

Women only


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

Form devised and created by Jane Chiodini © Updated 2018