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 travel questionnaire at least 8 weeks before your holiday departure date. One form for each person travelling. The practice will not be able to arrange vaccinations less than 8 weeks in advance, if a form is received under the 8 weeks’ notice you will be requested to contact a private clinic.

For non- NHS travel requirements, you will be asked to attend one of the private travel clinics where you will be advised if the costs depending upon your requirements.

Our NHS Travel services can only be provided to patients registered with East Norwich Medical Partnership.

Travel Vaccines information

Private Travel Clinics

Travel Risk Assessment

Travel Risk Assessment

Section

Sex:
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Holiday type:
Type of trip:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Including diabetes, heart or lung conditions
Have you ever had a serious reaction to a vaccine given to you before?
Does having an injection make you feel faint?
Do you or any close family members have epilepsy?
Do you have any history or mental illness including depression or anxiety?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Have you ever had any of the following vaccinations / malaria tablets?

Please state which year you had the vaccination(s):

*