Kingsbridge Travel Clinic

Kingsbridge Private Hospital Pre-Travel Health Questionnaire

Please note that travel vaccinations are required 6 weeks before your date of departure. If it is less than 6 weeks before your trip please call 0845 6006 352 and we can advise you on how we can help.

If you wish to book an appointment at the Travel Clinic, please ensure you complete ALL fields in the form below. Incomplete forms may cause a delay with your appointment.

Kingsbridge Travel Clinic

Personal Details

Medical History

Locations to be Visited


Women Only

Are you:

Conditions

 
 

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Allergies

 
 

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Vaccine History

Vaccine

Dates Given

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* Usually given as one vaccine