Queen Camel Medical Centre

01935 850225

Travel Advice

If you are going on holiday and think you may need travel vaccinations, please contact the surgery as early as possible, and definitely a minimum of 6 weeks before you travel.

Please complete the travel questionnaire below and submit.

We will then contact you to advise if you need any travel vaccinations and make an appointment for the free NHS vaccinations to have here at the suregery, due to the nature of your travel, non-NHS vaccines may also be advisable and if you require any of these the Practice Nurse will signpost you to a private travel clinic. We do not undertake private travel vaccines at the surgery.

Complete your travel form below:

Travel Health Questionnaire 2022

Travel Health Questionnaire

Queen Camel Medical Centre - Travel Health Questionnaire

Name(Required)
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Please fill in the sections below: (If more than 1 please use the cross symbol + right of this message to add more)
Country to be visited
Exact location or region
City or Rural
Length of stay
 
Have you taken out travel insurance for this trip?
Do you plan to travel abroad again in the future?
Type of travel and purpose of trip - Please tick all that apply

Please supply details of your personal medical history

1. Any allergies including food, latex, medication?
2. Severe reaction to a vaccine before?
3. Tendency to faint with injections?
4. Any surgical operations in the past, including e.g. your spleen or thymus gland removed?
5. Recent chemotherapy/ radiotherapy/ organ transplant?
6. Anaemia?
7. Bleeding/ Clotting disorders (including history of DVT)?
8. Heart disease (e.g. angina, high blood pressure)?
9. Diabetes?
10. Disability?
11. Epilepsy/ seizures?
12. Gastrointestinal (stomach) complaints?
13. Liver and or kidney problems?
14. HIV/AIDS?
15. Immune system condition?
16. Mental health issues (including anxiety, depression)?
17. Neurological (nervous system) illness?
18. Respiratory (lung) disease?
19. Rheumatology (joint) conditions?
20. Spleen problems?
21. Any other conditions?
22. Are you pregnant?
23. Are you breast feeding?
24. Are you planning pregnancy while away?
25. Have you undergone FGM/ been cut/ circumcised?
Please supply information on any vaccines or malaria tablets taken in the past
DD slash MM slash YYYY

Date published: 2nd June, 2020
Date last updated: 22nd November, 2022