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Travel Vaccinations

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.

1Your Details

please specify

2Your Travel Arrangements

3Destination(s)

Please give details of which countries and areas you are visiting along with the dates of your stay.

4Previous Immunisations

Please state whether you have had the following immunisations, along with the date given.

5Further Information

Further info: certain anti-malarial tablets can, in a small percentage of people, exacerbate epilepsy or Psychiatric illness.

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.

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© Neighbourhood Direct Ltd 2018
Istead Rise Surgery - Istead Rise Surgery, Worcester Close, Istead Rise, Gravesend, Kent, DA13 9LB
  • Telephone 01474 247003
Shorne Village Surgery - Crown Lane, Shorne, Gravesend, Kent, DA12 3DY
  • Telephone 01474 247003
Summerhouse Surgery - Beaconsfield Road, Bexley, Kent, DA5 2AE
  • Telephone 01322 402210
Practice Website supplied by Oldroyd Publishing Group
Your Neighbourhood Professionals. Just a Click Away! Need care but want to stay in your own home? J V A Electrical
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