This questionnaire should be filled in before seeing the Nurse for travel vaccinations.  If you do not already have an appointment arranged with the Nurse, please complete the questionnaire and contact us to arrange an appointment.  If you would prefer a printable version of the questionnaire please click here.


Travel Questionnaire
The date that you travel
The date you return from your travels, or the length of time you will be travelling for
Please list each country you will be travelling to and the length of time you will be spending in each