Vauxhall Practice 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 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.

Last Updated: 12/11/2024

  • Your Details

    Date of Birth
    For example, 15 3 1984
    Gender (optional)

  • Please supply information about your trip in the sections below

    Departure Date
    For example, 15 3 1984

  • Type of travel and purpose of trip - Please tick all that apply

    Purpose of Trip

  • Please supply details of your personal medical history

    Please give details to any you answer 'YES' to

  • Vaccination History

    Have you ever had any of the following vaccinations / tablets? (optional)
    THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.
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