Travel Questionnaire

Please keep in mind that in order to have your travel vaccine request processed and administered in time for your travel, this form must be submitted 6 weeks before your departure date. Please also be aware that we only offer NHS travel vaccinations.

Please enter your date of travel
Will you be travelling to your destination by:
Are you planning/anticipating doing any sporting activities?
What is the purpose of your Travel?
Have you had any of the following? (Please select those that apply)
Have you recently had any illness or dental treatment?
Are you pregnant?
Are you currently on any medication?