Travel Risk Assessment

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Personal Details
Please double check you've entered the correct email address
Trip location Information
Any travel risk assessments submitted with a departure date of less than 6-8 weeks away will not be actioned by our Travel Nurse
Type of travel & purpose of trip
Please supply details of your personal medical history

Women only 

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

Any travel risk assessments submitted with a departure date of less than 6 weeks away will not be actioned by our Travel Nurse

The Travel Nurse will assess your form in due course and contact you to book an appointment. 

Privacy Consent

This form collects personal and medical informanot tion about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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