Travel Advice Form

You can use this form if you are planning to travel abroad to a country where you may require additional vaccination or protection against malaria.

Once you have submitted the form you will need to phone the surgery to arrange a 20 minute travel appointment with the nurse. The nurse will be able to review the form prior to the appointment and so will already have been able to consider the vaccinations that you may need. This appointment should be at least 4 weeks prior to your departure for the vaccinations to have full effect. If you are travelling in less than 4 weeks then please submit the form and then advise the surgery about this. We will then get a nurse to speak to you on the telephone prior to the appointment.

Please note that while there is no charge for the appointment, some travel vaccinations and malaria tablets are not funded by the NHS and so there is a charge for these, which will need to be paid at the time of the appointment. For a list of charges please follow this link.

The form is not encypted and so if you are concerned about security then we suggest you use your 5 digit Practice Identification number. This number is unique to Binscombe and so will provide anonymity and is located at the top of your repeat prescription page. The reception staff can advise you of your number if you do not know what it is.

Please tick as appropriate below to best describe your trip Please tick only one box for each section

Are there any other comments you would like to make?