TRAVEL VACCINATIONS

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.

For more information please visit the NHS Travel Vaccination.

It is important to make this initial request as early as possible  - at least 8 weeks before you travel - as you may require multiple vaccinations. These vaccines have to be ordered as they are not a stock vaccine.  Your second appointment needs to be at least 2 weeks before you travel to allow the vaccines to work.

Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge.  This is because not all travel vaccinations are included in the services provided by the NHS.

Please complete the below form and a member of our Nursing team will be in touch.

 

Please complete all sections on this form for each individual traveller. 

Personal details

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Destination Details

Please supply information about your trip in the sections below.

City or Rural*
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Type of Travel

Please tick all that apply.

Type of Travel and Purpose of Trip (Please tick all that apply)*
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Medical History

Please supply details of your personal medical history.

Any allergies including food, latex and medication? *
Severe reaction to a vaccine before?*
Recent chemotherapy/ radiotherapy/ organ transplant*
Women only - Are you pregnant
Women only - Are you breast feeding
Women only - are you planning pregnancy while away
Have you undergone FGM/been cut/circumcised
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Medication

 

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Previous Vaccine History

Please supply information on any vaccines or malaria tablets taken in the past.

Please supply information on any vaccines or malaria tablets taken in the past.*
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Additional Information

 

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