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Pre-Travel Questionnaire

If you require any vaccinations relating to foreign travel you need to make an appointment with the practice nurse, who runs a clinic on every Thursday afternoon, to discuss your travel arrangements. This will include which countries and areas within countries that you are visiting to determine what vaccinations are required.

To help us offer the appropriate advice, please fill out the travel form before coming to see the nurse. If this completed form can be handed in at reception when you book the appointment six weeks prior to your travel, this will allow the practice nurse enough time to prepare appropriate course of vaccines for your travel.

Click here to download the travel clinic fees.

1Pre-Travel Questionnaire

2Destinations

In the question about the countries you will be visiting please give details of the resort/region as well as the country. Remember to list any countries you will be travelling through as well as those you’ll be staying in

3Medical History

Please give details of any conditions that may affect your travel plans

4Vaccination History

Please give details of any previous vaccinations and anti-malarial medications below. If you have had any of the vaccinations please provide the date and any comments e.g. if you experienced any problems or side effects.

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

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! British Cardiologist Expert Aesthetics Nutrisential Natasha Basile-Gracey
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Main Surgery - Talbot Road, Alderley Edge, Cheshire, SK9 7EP
  • Telephone 01625 584 545
Prestbury Surgery - Hope Cottage, Macclesfield Road, Prestbury, Macclesfield, Cheshire, SK10 4BW
  • Telephone 01625 827 319
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Your Neighbourhood Professionals. Just a Click Away! British Cardiologist Expert Aesthetics Nutrisential Natasha Basile-Gracey
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