Travel Questionnaire - FOR REGISTERED PATIENTS ONLY

PLEASE NOTE WE NEED FOUR WEEKS NOTICE FOR ANY TRAVEL VACCINATIONS.  This gives our Team enough time to investigate through your medical record what vaccinations are needed and also to order in the necessary vaccines to complete any courses needed.  Some courses of vaccinations have to be given over a four week period.  Once you have completed and submitted this form, please give the Surgery a call in approximately five working days (excluding weekends and Bank Holidays) to see what vaccinations you may be due.  This will give the Nursing Team enough time to review your previous vaccinations and see what is overdue or needed.  Many thanks.  PLEASE DO NOT COMPLETE THIS QUESTIONNAIRE UNLESS YOU ARE A REGISTERED PATIENT AT RAMSBURY & WANBOROUGH SURGERY.

Gender

Please provide details of your trip including dates and departure

Purpose of trip
Type of trip
Accommodation
Travelling
Location type
Activity type

Personal medical history

Please select the following that apply
Have you ever had any of the following vaccinations / tablets?