Travel Risk Assessment

Travel Risk Assessment

Please complete the form below before you travel, and we will contact you to arrange any vaccinations that you may need

"*" indicates required fields

Name*
Date of Birth*
Are you a patient at Trinity Medical Centre?*

Please supply as much information about your trip as possible

Date of Departure*
Have you taken out travel insurance for this trip?*
Do you plan to travel abroad again in the near future?*
Type of Travel and Purpose of Trip*
Are you fit and well in general?*
Any allergies including food, latex, medication?*
Have you had a severe reaction to a vaccine before?*
Do any of the following apply to you?
Have you had any of these vaccines/tablets previously?