Torkard Hill Medical centre
Travel health advice and vaccinations
For advice on Travel, please contact the reception on 0115 963 3676
When planning your holiday it is important that you have accurate up-to-date advice about what
immunisations and antimalarial protection you might need. Providing travel advice is a core part of the role
of our experienced Practice Nursing team
Prior to booking a nurse travel appointment, you will need to complete a Travel Clinic Questionnaire which
can be downloaded here (insert hyperlink) or collected from reception. One of Practice Nurses will then
contact you within 7 days of receipt of your form to arrange a convenient appointment. If you are advised
that you need the following vaccinations, these are available free of charge from the Practice:
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Hepatitis A
Typhoid
Tetanus
Diptheria
Polio
The NHS does not cover the cost of other travel vaccinations, such as Rabies, Yellow Fever, Hepatitis B,
Japanese encephalitis, and Anti-malarial tablets. You will incur a charge if you require these vaccinations
for your travel.
We would like to remind all our patients that many travel vaccines and medications take several weeks to
provide protection. It is vital therefore that you book your consultation in sufficient time before your
holiday.
Ideally, please contact the Practice 6-8 weeks in advance of travel. The practice does not provide a service
for last-minute travellers, if you need urgent travel advice contact Travel doc at Regent Street Freephone
0800 583 3331 or The Walk-in Centre on London Road, Nottingham telephone: 0115 8838500.
For further information about countries and required vaccinations, please see the links below.
Links to websites on travel health:
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Travel Health
www.travelhealth.co.uk
Fit for Travel
www.fitfortravel.scot.nhs.uk
Foreign and Commonwealth Office
www.fco.gov.uk/en/travel-and-living-abroad/
Travewww.traveldoctor.co.uk
Torkard Hill Medical Centre
Travel Vaccination Questionnaire
One form per person travelling. Traveller to complete.
Name of Traveller:
Date of Birth:
Travel Itinerary
Date of Departure:
Destinations(s) & duration of stay in each place:
Type of Holiday (delete as applicable):
Holiday / Businesss / VFR / Other (please state):
Accommodation (delete as applicable):
Hotel / Hostel / Family home / Other (please state):
Any High Risk Activities Planned:
(eg. Back packing, snorkelling, safari) Please state:
Medical History
Past/Current Medical History:
Allergies:
(Food, Drugs, Animals, Plants)
Are you taking steroids:
Do you have HIV:
Are you pregnant:
Are you planning pregnancy:
Are you taking the contraceptive pill:
Have you had ANY previous reactions to any
vaccinations:
Yes
Yes
Yes
Yes
Yes
Yes
/
/
/
/
/
/
No
No
No
No
No
No
Previous Vaccination Hisotry (if known)
Vaccination
Tetanus
Diptheria
Polio
Date
Typhoid
Hep A
Hep B
Other
All the information given is correct and up to date:
Signed:
Date:
Please note:
*Please return the completed form to the surgery at least 6 weeks before your departure date and the nurse will contact you to arrange an
appointment.
FOR PRACTICE NURSE USE ONLY:
Vaccine
Tick if
BN & Expiry Date
required
Date
Given
Injection Site
Signed
Hep A
Hep B
Hep A & B
Hep A with Typhoid
Dip / Tet/ Polio
Typhoid
Meningitis
Name of Prescribing Practitioner:
Date:
Signature:
Malaria Tablets:
Tablets
Mefloquine
Doxycycline
Atovaquone plus Proguanil
Chloroquine
Proguanil
Recommended
Chosen
Number Required
Child Weight:
Recommended Anti-Malarial Dose:
Additional Comments:
Travel Record Card Given:
Yes / No / Updated
Appointment Date & Time:
Appointment with:
Signed (Practice Nurse):