We now offer a range of travel vaccinations including Yellow Fever, Rabies & Meningitis ACWY If you require any vaccinations relating to foreign travel please complete a travel health form (this can be downloaded from this website or collected from reception). Complete it, hand it in and call the surgery after 7 days to find out what you need & make an appointment with the practice nurse at least 6 weeks before your travel date. These vaccines have to be ordered as they are not stock items. Some vaccinations incur a charge as they are not included in the services provided by the NHS.
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.
Have you had the following vaccinations? If you have please advise when.
PLEASE ALLOW ONE WEEK FOR THIS FORM TO BE LOOKED AT BEFORE CALLING TO MAKE AN APPOINTMENT. Most vaccinations need to be administered at least 2 weeks before travel. Some vaccinations need to be given as a course which needs to be completed prior to travel
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.
I consent to my information being used for the purposes described above and wish to submit this online form to
Blackpond Lane, Farnham Common, Buckinghamshire, SL2 3ER.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.