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.

Please use this date format: DD/MM/YYYY.
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Please write your name. For discussion when risk assessment is performed within your appointment. I have no reason to think that I might be pregnant. I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to ask questions. I consent to the vaccines being given.

Please note that the details you give will be used to update your medical records.

For Official Use

Travel vaccines recommended for this trip

Travel advice and leaflets given as per travel protocol

Malaria prevention advice and malaria chemoprophylaxis

Further information

Authorisation for Patient Specific Direction (PSD) Use