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. To help the Travel Nurses assess your travel needs it is important that they are in receipt of the assessment form before your appointment. Please be aware that we require at least 6 weeks notice before you travel to allow time for your vaccinations.


Name
Date of Birth
Email
Gender

Details about your trip

Date of Departure

Description of your trip

Purpose of your trip

Personal Medical History