Upton Group Practice

Travel Advice Questionnaire

To help us give the best advice to travellers and the necessary vaccinations to keep them healthy and disease free abroad we need to have all the information requested on this form.  Please print this form, complete the details and return it to the practice for the attention of the Practice Nurse at least a month (preferably longer) before you are due to travel.

Travellers name:

 Home Address & Phone number:

 Date of Departure and how long are you away?

 Which country or countries are you travelling to?

 Which resorts/areas are you visiting?

 Details of any additional trips, jungle excursions, safaris etc?

 Are you doing any “stop offs”? If so where?

 What sort of accommodation will you be staying in e.g. cruise-ship, hotel, camping, backpacking etc.

 Please note: If you have booked at short notice you may not have left enough time to complete all the recommended vaccinations and we may not have travel appointments available.

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Last modified: 15/09/2005