Travel Medicine Booking Form

Fill in the form below to apply for your appointment. One of our team will contact you within 2 working days to confirm.

  **Please note vaccinations may be able to be given at the time of the travel consult, but you may be required to have a follow up appointment if vaccinations need to be ordered in.

Medical History

Travel Details

What type of accommodation will you be staying in?

If you have had travel immunisation before please complete the date given beside the immunisation you have had?

Immunisation History