Copy of - Travel Risk Assessment V2

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: 20/03/2024

Your Details








Trip Details






Country to be Visited

Please list down all the countries and regions you are planing to travel 




Trip Description

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



Personal Medical History

Please supply details of your personal medical history 




















Women Only





Current Medication

Are you currently taking medcation? 


Vaccination History

Please supply information on any vaccines or malaria tablests taken in the past





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