Show Side Menu

Travel Questionnaire

Please complete the following form to request immunisation appropriate to your travel plans together with advice on anti-malarial drugs.

Failure to complete the form correctly and in full may delay your vaccination programme.

1Personal Details

2Trip Details

3Destination(s)

Please give details of which countries you are visiting.

4Personal Medical History


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away! J V A Electrical
Istead Rise Surgery - Istead Rise Surgery, Worcester Close, Istead Rise, Gravesend, Kent, DA13 9LB
  • Telephone 01474 247003
Shorne Village Surgery - Crown Lane, Shorne, Gravesend, Kent, DA12 3DY
  • Telephone 01474 247003
Summerhouse Surgery - Beaconsfield Road, Bexley, Kent, DA5 2AE
  • Telephone 01322 402210
Website supplied by Oldroyd Publishing Group
Your Neighbourhood Professionals. Just a Click Away! J V A Electrical
Back to top