Travel form

Travel Service

We offer a full travel advice and NHS immunisation service. Please choose a topic to see more information.

Travel Health | Masta | Gov.uk | Travel Pro | EHIC

If you require any vaccinations relating to foreign travel, you need to complete our online travel form.

Please note you need to give at least 8 – 12 weeks notice, as these vaccines have to be ordered, as they are not a stock vaccine. You need to have the vaccine at least 2 – 4 weeks before the date of your travel to allow the vaccines to work.

Some travel vaccines are ordered on a private prescription and these incur a charge over and above the normal prescription charge. This is because not all travel vaccinations are included in the services provided by the NHS.

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Pregnancy
Travel Form

Travelling In Pregnancy

Some women prefer not to travel in the first 12 weeks of pregnancy because of nausea and vomiting and feeling very tired during these early stages. The risk of miscarriage is also higher in the first 3 months, whether you’re travelling or not. So, many women find the best time to travel or take a holiday is in mid-pregnancy, between 4 and 6 months.

With pregnant women there are increase risks for long distance travel including increased DVT risk for long haul flights, limited access to adequate health care in some areas, Zika virus reported in many countries, most malaria tabs and some vaccines contraindicated in pregnancy.

We advise that women who are pregnant or planning pregnancy should not book travel outside Europe without first booking to speak with one of our nurses.

Travel Risk Assessment Form

  • Basic information
  • Personal Medical History
  • Vaccination history

Personal information

First name

Surname

Date of birth

Phone number

Email Address

Dates of trip

Date of departure

Return date of trip

Itinerary and purpose of visit

Country to be visited

Length of stay (In days)

Away from medical destination, if so how remote?

Trip Description

Type of trip

Holiday type

Accommodation

Travelling

Staying in area which is

Planned activities

Medical background

Do you have any recent or past medical history of note?

List any current or repeat medications

Do you have any allergies for example to eggs, antibiotics, nuts?

Have you ever had a serious reaction to a vaccine given to you before?

Does having a serious injection make you feel feint?

Do you or any close family members have epilepsy?

Do you have any history of mental illness including depression or anxiety ?

Have you recently undergone radiotherapy, chemotherapy or steroid treatment?

Women only : Are you pregnant or planning pregnancy or breast feeding?

Have you taken out any travel insurance and if you have a medical condition , informed the insurance company about this?

Please write below any further information which may be relevant

Vaccination history

Have you ever had any of the following vaccinations / malaria tablets and if so when?

Confirmations

For discussion when risk assessment is performed within your appointment. I have no reason to think that i might be pregnant. I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to ask questions. I consent to the vaccines being given.

Signed

Date

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