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Travel Vaccinations

Please complete the Travel form (to request immunisations appropriate to your travel plans (or call into the surgery to pick up a Travel form) once completed bring to the reception.

The Nurse will review your form, reception will then make contact  with you with regards to making an appointment to see the Nurse for your immunisations together with advice on anti-malarial - please note that you may not receive all the immunisations within this appointment, you may have to come back to complete the course of treatment/receive all immunisations (the Nurse will discuss this with you)

Please note that the travel form is only for patients registered at The Apples Medical Centre


 

 

Appointment Details
Please provide in the format DD/MM/YYYY
HH:MM
Your Details
Please provide in the format dd/mm/yyyy
Your Travel Arrangements
Please provide in the format DD/MM/YYYY
Destinations

Please give details of which countries and areas you are visiting along with the dates of your stay.

Country 1


Country 2


Country 3


Previous Immunisations

Please state whether you have had the following immunisations, along with the date given.


Further Information
Further info: certain anti-malarial tablets can, in a small percentage of people, exacerbate epilepsy or Psychiatric illness.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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