Travel Vaccination Form - Kingsway Surgery

Travel Vaccinations

Some of our practice nursing team are able to provide advice for those jetting off to far away shores however, we are only able to administer Hepatitis A, tetanus, polio and typhoid vaccinations to those who need them (although we are not a registered Yellow Fever Centre), as many vaccinations recommended for overseas travel are not available on the NHS and you will be required to pay for these vaccines. Appointments can be arranged via a local vaccination centre at Superdrug (click here) or Boots (click here).

Some malaria treatments are available from the pharmacist, who may be able to advise and supply these when appropriate.

It is imperative that you seek advice regarding travel vaccinations well in advance of your intended departure date (at least 8 weeks), as they often need to be given well in advance of travel.

You can check which vaccinations you may need by clicking the link below.

Do I need a travel vaccine?

Name

Address

Date Of Birth

Phone Number

Email Address

Further Information

List Destinations - Country or Resort (Include any stopovers on the journey)

Date of Travel

Length of Stay

TYPE OF ACCOMMODATION (e.g. hotel, self catering, camping, backpacking, etc )

Are you pregnant or might you be before you travel?

Yes

Please list any known allergies

Please select which Travel Vaccines you need?

Hepatitis A
Tetanus
Typhoid

If 'other' please state what travel vaccinations you need

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

Yes