Risk Assessment for Vaccinations

The practice is able to provide a basic provision for patients wishing to travel abroad and can provide all of the NHS vaccines.

Please note this practice is not a travel clinic therefore if specialist travel advice is required or specialist vaccinations are needed (for example rabies, yellow fever) this must be sourced from a specialist travel clinic. Malaria prevention tablets can be purchased from most high street chemists.

The following NHS vaccines for travel are available in Haygarth surgery:

  • Diphtheria, Polio and Tetanus (combined vaccine)
  • Typhoid
  • Hepatitis A
  • Cholera

Please allow at least 6-8 weeks prior to departure date to help us to try to meet your travel vaccination needs.

Risk Assessment for Vaccinations

Risk Assessment for Vaccinations

Sex:
Please use this date format: DD/MM/YYYY
Please use this date format: DD/MM/YYYY
Holiday type:
Type of trip:
Accommodation:
Travelling:
Staying in area which is:
Planned activities:
Including diabetes, heart or lung conditions
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 or mental illness including depression or anxiety?
Have you recently undergone radiotherapy, chemotherapy or steroid treatment?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Have you ever had any of the following vaccinations / malaria tablets?

Please state which year you had the vaccination(s):

*