Travel Advice form - Springwell Medical Centre

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ONE PER TRAVELLER
TRAVEL ADVICE
Going Abroad on Holiday or Business? You may need travel vaccinations, depending on
the country or countries that you intend to visit.
To help advise you on the protection you need, please get advice at least 3 months before
you travel, as some complicated regimes may require three or more appointments.
NAME:
___________________________________
Address:
_________________________________________________________
Telephone Number(s):
DOB: ______________
_____________________
_____________________
Which countries do you intend to visit (including brief stopovers)? It is helpful to give as
much detail as possible:
________________________________________________________________________
________________________________________________________________________
_________________________________________________________
Will you be staying in hotels or under more primitive condition (e.g. camping)?
___________________________________________________________________
Are you visiting friends or relatives?
YES
□
NO
□
Do you plan any safaris, jungle exploration or travel in difficult terrain?
________________________________________________________________________
________________________________________________________________________
_________________________________________________________
Departure Date:
Duration of stay abroad:
_________________
_________________
Have you ever had any of the following vaccinations and if so when:
Typhoid
Tetanus
Polio
Hepatitis B
□_______________
□_______________
□_______________
□_______________
Are you allergic to anything?
Yellow Fever
Diphtheria
Hepatitis A
Cholera
□_______________
□_______________
□_______________
□_______________
________________________________________
Are you taking any medicines? There is no need to list medication you have on repeat
prescription but please include any medicines you buy yourself in pharmacies:
________________________________________________________________________
________________________________________________________________________
_________________________________________________________
Remember: if you are receiving any medication, make sure that you take enough supplies
to last through your overseas visit.
ONE PER TRAVELLER
Immunisations Required
Doses
Dip/Tet/Polio
Hepatitis A
Thyphoid
Hepatitis B
Meningitis A C W Y
Japanese Type E Encephalitis
Tick Borne Encephalitis
Rabies
Cholera (Dukorel)
Yellow Fever*
BCG**
Malaria Drugs Required





Free of charge
Free of charge
Free of charge
Prescription cost £20 + Pharmacist charge
Prescription cost £20 + Pharmacist charge
Prescription cost £20 + Pharmacist charge
Prescription cost £20 + Pharmacist charge
Prescription cost £20 + Pharmacist charge
Prescription cost £20 + Pharmacist charge
Not available in the surgery – travel clinic
Not available in the surgery – travel clinic
Prescription cost £20 + Pharmacist charge
You may be advised to take more than one antimalarial drug.
Chloroquine and Proguanil are available from pharmacies without a prescription.
You will need a prescripiotn for malarone, doxycycline and mefloquine.
If you have been given a choice of two or more antimalarials you should discuss
your choice with a doctor either by making an appointment or by telephone.
Antimalarials are not available on NHS prescription. The pharmacy will charge for
the drugs
*Yellow Fever available from:
**BCG available from:
Edinburgh Travel Clinic
Superdrug Health Clinic
Davidson Mains Medical Centre
Edinburgh Travel Clinic
If you wish you can attend any of the Travel Clinics listed below:
Edinburgh Travel Clinic
14 East Preston Street
Edinburgh
EH8 9QA
0131 667 1030
Superdrug Health Clinic
83 Princes Street
Edinburgh
EH2 2ER
0845 026 0830
Western General Hospital
Crewe Road South
Edinburgh
EH4 2XU
01131 537 2822
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