Travel Vaccination Questionnaire

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against many travel-related infections, such as yellow fevertyphoid and hepatitis A.

In the UK, the childhood vaccination programme protects you against a number of diseases such as tetanus, but it does not cover most of the infectious diseases that are found overseas.   

You can find a record of your vaccination history on your SystmOnline Medical Record.  If you have not set-up access to your online Medical Record yet please telephone the surgery to arrange.

 

Travel vaccinations

You can find out which vaccinations are necessary or recommended for the areas you will be visiting on these two websites:

Please refer to our Travel Vaccination Information before completing this form as we do not provide a full travel health service here at the Practice.


Travel Vaccination Questionnaire
Please supply information about your trip in the sections below
Please supply details of your personal medical history
Women only
Medication
Please supply information on any vaccines or malaria tablets taken in the past
Additional Information

Privacy Protection

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All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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