Pre Travel Assessment

Pre Travel Assessment

If you are travelling abroad please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. To help the Travel Clinic Nurses assess your needs it is important that they are in receipt of the assessment form before your appointment. Please be aware that we require at least 6 weeks notice before you travel to allow time for your vaccinations.

Print out the FIT FOR TRAVEL information relating to the countries you will be visiting (www.fitfortravel.nhs.co.uk) –don’t forget to check out what anti-malarials you may need (Please note: the surgery does not provide prescriptions for anti-malarials, either HNS or Private, including for those under 18. If you require this service please contact a local travel clinic – details below)

If you are travelling at short notice (or leave things to the last minute) it is unlikely we will be able to assess the risks of your personal travel itinerary and give the necessary advice or vaccines. Alternatively you should arrange a private appointment with either Masta (0330 100 4200) or Boots (0345 301 4219) or look online for other local clinics. 

  • Your Details

    Date of Birth
    For example, 15 3 1984
    Gender

  • Trip Details

    Departure Date
    For example, 15 3 1984

  • Trip Description

    Purpose of Trip
    Type of Trip
    Accommodation (optional)
    Travelling (optional)
    Location Type (optional)
    Activity type (optional)

  • Personal Medical History

    Have you ever had a serious reaction to a previous vaccine?
    Have you recently suffered from any infection (e.g heavy cold, flu or high temperature)?
    Does having an injection cause you to 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?
    Have you taken out travel insurance?
    If you have a medical condition, have you told your insurance company about it?
    Are you pregnant, planning pregnancy or breast feeding?

  • Vaccination History

    Have you ever had any of the following vaccinations / tablets and if so, when?
    THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.

  • The following are not available under the NHS and therefore the following charge is made:

     

     

    Item

    Minimum time before travel for completed course

     

     

    Number of doses

     

     

    Cost per dose (£)

     

     

    Total cost (£)

    Hepatitis B

    4-9 weeks

    (preferably 6 months)

    3 (or 4)

    £63.00

    (Booster)

    £187.00 (£247.00)

    Hepatitis B Junior

    6 months

    3

     

    £215.00

    Meningitis ACWY

    2 weeks

    1

    £77.00

    £77.00

    Rabies (pre exposure only)

    4 weeks

    3

     

    £243.00

    Japanese Encephalitis

    4 weeks

     2

     

    £310.00 

    Tick borne Encephalitis

    6 weeks

    Adult: 3

     

    Child: 2

    £91.00

    (Booster)

    £83.00

    (Booster)

    £158.00

     

    £141.00

     

    Administration:

    Completion of previous vaccination record card

    £25.00

    Signed certificate of medication 

    £20.00

     

    Please note:

    • Payment is due prior to vaccination
    • It is your responsibility to ensure you have the recommended vaccines

    • New Road Surgery DOES NOT prescribe benzodiazapines for fear of flying please see this link for the full policy

    • New Road surgery does not provide yellow fever vaccinations or private prescriptions for antimalarials, if you require these services please contact a local travel clinic for advice.

  • General Travel Advice

    ·      Ensure you have read thoroughly the information on all the countries that you intend to visit on www.fitfortravel.nhs.co.uk

    ·      Protect yourself against skin cancer – use protective sun block, applying frequently

    ·      Do everything you can to NOT get bitten by insects. Use at least 30-50% DEET on all exposed skin, reapplying frequently on top of any other creams so that the insect smells the repellent in order to be repelled.

    ·      For information about applying for a UK Global Health Insurance Card (UK GHIC) or a UK European Health Insurance Card (UK EHIC), if you have rights under the Withdrawal Agreement. Visit: https://www.nhs.uk/using-the-nhs/healthcare-abroad/apply-for-a-free-uk-global-health-insurance-card-ghic/

    ·      Consider flight stockings for flights of more than 4hours with the increased risk of blood clots

    ·      Consider taking anti-diarrhoeal tablets, re-hydration sachets, alcohol gel and first aid kit

    ·      Ensure you take out EXCELLENT TRAVEL HEALTH INSURANCE, check that it covers air ambulance and repatriation to the UK

    ·      Food and drink: COOK IT, PEEL IT OR LEAVE IT OUT! IF IN DOUBT, LEAVE IT OUT!

    ·      Excessive alcohol can make you carefree and lead you to take risks you would otherwise not consider

    ·      Safe sex: www.mariestopes.org.uk/documents/travelguide.pdf

    ·      Take precautions against accidents eg wear safety equipment

    ·      Ensure you know specific road/driving laws of the country visited

     

    I confirm that I have read and understood all the information provided above, including all relevant information on the FIT FOR TRAVEL website relating to the countries I will be visiting (www.fitfortravel.nhs.co.uk).
This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Page last reviewed: 24 July 2025
Page created: 19 March 2024