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Shotfield Medical Practice Providing NHS services
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Home > Travel Form

Travel Form

If you are travelling abroad and require advice and/or vaccinations you will need to download the travel vaccination and enquiry form (see below) which you should complete and hand in to reception. Once the form has been completed in full and returned to us you can make an appointment with the nurse. Alternatively it can be completed online below. The form should be submitted and the appointment arranged 6 to 8 weeks before you travel to ensure that any course of vaccinations required can be appropriately completed and be considered effective.

Please download the travel vaccination form (DOCX, 24KB) including details of our current charges for vaccinations.

All payments can be made by cash, cheque or visa. Travel vaccination charges where these apply will need to be paid on the first visit and for any courses these are non-refundable.

Please note there is currently a national shortage of Hepatitis A&B vaccine so the practice cannot provide these at the present time. The nurse will advise you if these vaccines are available alternatively you can consult with a local private travel clinic.

Diazepam for fear of flying

The Doctors have taken the decision not to prescribe diazepam in cases where the there is a fear of flying. More information here.

Travel Form

Travel risk assessment and enquiry form – to be completed by the traveller 6-8 weeks prior to travel and prior to an appointment being made with the nurse.

Type of travel and purpose of trip (please tick all that apply):
Medical History

Please provide details about your personal medical history below:

Women Only
Vaccinations


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 and is accessed over a secure connection by nominated staff. We have 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.


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Shotfield Medical Practice

Shotfield, Wallington, Surrey, SM6 0HY

  • 020 8669 7612
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Local Services
Funeral
Plans
Wills
& LPA
Residential/
Nursing Care
Home
Care
Private
Dentist
Home
Care
Jobs
Aesthetic
Clinic
Counselling