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Travel risk assessment

Travel Risk Assessment

Section

Please use this date format: DD/MM/YYYY
What type of areas are you visiting?
For example, business, holiday, seeing family, religious, backpacking, charity.
Who are you traveling with?

You will need to complete this form once for each person traveling with you. If one of the people traveling with you is not registered here, they will need to contact their own GP to arrange a travel vaccination appointment.

Are you currently taking any medications, including contraception?
Do you have any current health conditions?
Are you currently taking a short course of medication such as antibiotics?
Do you have any allergies?
Have you ever had a reaction to a vaccine or malaria tablets in the past?
Have you ever had any of the following vaccinations / malaria tablets?

Please state which year you had the vaccination(s):

Are you pregnant, planning pregnancy or breast feeding?
Confirmation