Travel Survey

Please complete this as much as possible to assist your doctor when it comes to your travel consultation.
Having this information in one place, clarifies and details any issues and challenges that need to be managed while travelling.

PLEASE NOTE: 
Currently we are unable to administer the Yellow Fever vaccine that is recommended for a number of African and South American countries. 

With this in mind, please take care to consider the first part of the form, if you are travelling to, or through one or more of the countries listed, you will need to organise this through another local provider.