Travel Questionnaire

If you are travelling abroad, please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. WE CANNOT ACCEPT ANY FORMS WHERE YOU ARE TRAVELLING WITHIN 6 WEEKS OF SUBMISSION.

Our Practice Nurses are specially qualified to give you comprehensive advice regarding the vaccinations, malaria prophylaxis and other health considerations relating to travel abroad. The costs of a number of these vaccines are not covered by the NHS and you will be charged for these (for price lists please ask at reception). For the same reason prescriptions for anti-malaria drugs are issued as private prescriptions. Some anti-malaria drugs are available over the counter, you need to check with the nurse first to ensure that the drug you are intending to take is appropriate for the area you intend travelling to.

If you are travelling within 6 weeks, DO NOT COMPLETE THE FORM BELOW as you are travelling too soon for us to provide the vaccinations. You can contact one of the below travel clinics for advice:

  • Health Hub, 1B Queen Street, Lancaster. Tel: 01524 580 999

  • Manchester Airport Terminal 1, OH Unit. Tel: 0161 489 3962

  • City Doc Blackpool, Whitworth Pharmacy, 292-294 Waterloo Road, Blackpool. Tel: 0845        026 0830

  • www.lastminutejabs.co.uk, Wilmslow Health Centre. Tel: 01625 547 777

Last Updated: 08/07/2024

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Trip Details




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Personal Medical History














Vaccination History



Availability

Our reception team will book you a telephone consultation with one of our Practice Nurses to discuss your travel vaccinations, and arrange your appointment to receive them. It is important that this is done as early as possible before you travel.

Following your submission oif this form, we will book you into the next available telephone appointment and text you the details. Please allow 2-3 working days after your submission for us to process this. If this appointment is unsuitable, please contact us on 01539 718 080 option 1 to rearrange.


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