Travel Vaccinations - St Albans Medical Centre

If you require any vaccinations relating to foreign travel you need to make an appointment with the practice nurse to discuss your travel arrangements. This will include which countries and areas within countries that you are visiting to determine what vaccinations are required.

Some vaccinations including Yellow Fever, Japanese encephalitis and rabies are not available on the NHS and there will be a charge for these vaccinations.

There is further information about countries and vaccinations required on the links below

It is important to make this initial appointment as early as possible - at least 8 weeks before you travel. Please be aware that most vaccines take at least 10 days to be effective and if you need to take malaria medication it has to be taken one week prior to travel.

Travel Health Questionnaire

To help us offer the appropriate advice, please complete a travel form as below and bring it with you to the surgery or you can complete it online below.

Please allow us at least 4 working days to do an assessment before contacting us to book your appointment.

Travelling in Europe

A very useful booklet has been published with advice and guidance to help you get the most out of your holiday.

Travel Vaccinations

Name

Date of Birth

Gender

Telephone Number

Email Address

Dates of trip

Date of departure

Return date or overall length of trip

Itinerary and purpose of visit

Country 1

Length of stay at Country 1

Country 2

Length of stay at Country 2

Country 3

Length of stay at Country 3

Will you be away from medical help at any of the destinations, if so how remote?

Type of Trip

Business

Pleasure

Other

Accommodation

Hotel

Relatives/family home

Other

Travelling

Alone

With family/friends

In a group

Staying in area which is:

Urban

Rural

Altitude

Planned Activities

Safari

Adventure

Other

Personal Medical History

Do you have any recent or past medical history of note? ( including diabetes, heart or lung conditions)

List any current or repeat medications

Do you have any allergies for example to eggs, antibiotics, nuts or latex?

Have you ever had a serious reaction to a vaccine given to you before?

Does having an injection make you feel faint?

Do you or any close family members have epilepsy?

Do you have any history of mental illness including depression or anxiety?

Have you recently undergone radiotherapy, chemotherapy or steroid treatment?

Women only: Are you pregnant or planning pregnancy or breastfeeding?

Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?

Please provide any further information that may be relevant

Vaccination History

Vaccination History Have you ever had any of the following vaccinations / malaria tablets and if so please specify when?

Tetanus

Polio

Diptheria

Typhoid

Hepatitis A

Hepatitis B

Meninigitis

Yellow Fever

Influenza

Rabies

Jap B Enceph

Tick Borne

Other, please specify

Malaria tablets

I have no reason to think that I might be pregnant.

I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to questions.

I consent to the vaccines being given

***FOR SURGERY USE ONLY***

These questions are for surgery use only. Please do not answer them.

Authorisation for Patient Specific Direction (PSD) use

Assessor's Name

Signature

Date

Prescriber's Name

Signature

Date

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