Travel Risk Assessment

 

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Personal Details

Please note that we do NOT offer fellow fever vaccine

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.

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May be used to identify you
Dates and Trip Details
Personal Medical History
Including diabetes, heart or lung conditions
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This form is automatically dated upon submission.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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