Pre Travel WorkSheet - NB Please complete all * sections

Previous Immunisations and Dates

Important past/current medical problems (please tick)

Females Only

Terms and Conditions:

Please note once you have sent this form that there is a charge from this point for the Nurses and Doctors time, regardless whether you are vaccinated or not. This charge covers the time taken to research and work out your vaccination requirements plus your travel consultation with the nurse.