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Travel Clinic Appointments

If you require any vaccinations relating to foreign travel, please complete this pre-appointment questionnaire online.
 
The nurse will then check the details and ask the reception team to call you to book an appointment.
 
Please allow as much time as possible before you travel - we will aim to call you to arrange your appointment within a week of you submitting this information.
 
You can also request a form at the reception desk. 
 
There is further information about countries and vaccinations required at www.fitfortravel.nhs.uk  
Travel Clinic Appointments
Please enter the best number to reach you on
Information About Your Trip
Country No.1
Country No. 2
Country No. 3
.
Please supply details of your personal medical history
Women only
(including prescribed, purchased or a contraceptive pill)

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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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