PMP Travel Risk Assessment

PMP Travel Risk Assessment

If you are travelling abroad please make sure you contact us in plenty of time to arrange any vaccinations that may be necessary. Please be aware that we require atleast 6 weeks notice before you travel to allow time for your vaccinations. This form will be reviewed by our travel nurse in the next 2 - 3 weeks, if you have not heard from us within 2 weeks please call us on 0118 984 2234.

Please visit the NathNac travel advise website before submitting this form so that you are aware of the travel advice and vaccine requirements for your destination: NaTHNaC - Country List

  • Your Details

    Date of Birth
    For example, 15 3 1984
    Gender

  • Trip Details

    Departure Date
    For example, 15 3 1984

  • Trip Description

    Purpose of Trip (optional)
    Type of Trip (optional)
    Accommidation (optional)
    Travelling (optional)
    Location Type (optional)
    Activity type (optional)

  • Personal Medical History

    Have you recently suffered from any infection (e.g heavy cold, flu or high temperature)? (optional)
    Does having an injection cause you to feel faint? (optional)
    Do you or any close family members have epilepsy? (optional)
    Do you have any history of mental illness including depression or anxiety? (optional)
    Have you recently undergone radiotherapy, chemotherapy or steroid treatment? (optional)
    Have you taken out travel insurance? (optional)
    If you have a medical condition, have you told your insurance company about it? (optional)
    Are you pregnant, planning pregnancy or breast feeding? (optional)

  • Vaccination History

    Have you ever had any of the following vaccinations / tablets and if so, when? (optional)
    The travel nurse will review your form within the next 2-3 weeks. If you haven't heard from us after 2 weeks please call us. If you need more urgent travel advice or vaccines, please contact an alternative travel clinic.
    THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA.
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Page last reviewed: 08 December 2025
Page created: 27 October 2025