Travel Advice and Immunisations
PLEASE KEEP THIS SHEET FOR YOUR INFORMATION
Please fill in a travel form (attached) available from reception at least 6 weeksprior to travelling because some immunisations require more than one dose to complete a course, or take time before they are effective. Pressure on appointments is high and therefore you may not be able to book an appointment immediately. Please contact the travel health website for a wide range of travel health advice.
After you have submitted your form one of our nurses will call you to discuss your immunisations; if after one week you have not heard from us please call the surgery.
We stock and supply the following vaccines free of charge:
PolioTyphoidTetanusDiphtheria
Hepatitis A and Hepatitis A/Typhoid (currently out of stock - national shortage)
These vaccines are chargeable:
Hepatitis B £50Hepatitis A & B £50 (only child immunisations in stock)
Yellow fever / Rabies & Japanese B EncephalitisThis vaccination is available here. £60 for registered patients, £65 for unregistered/temporary resident patients: PAYABLE ONLY IN CASH (no cheques).
It is also available at the following specialist centres:
Masta Travel Clinic 0330 100 4300
Trailfinders Travel Clinic: 020 7938 3999
The Royal Free Travel Clinic: 020 7830 2885 / These vaccinations are available from Travel Clinics.
Malaria
Advice on the type of medication for your trip can be obtained from: MASTA 0330 100 4300.
If you need any of the following malaria prevention medicines, you can buy them over the counter from a community pharmacy without a private prescription.
chloroquine (Avloclor ®)
proguanil (Paludrine ®)
chloroquine with proguanil (Avloclor/Paludrine ®) atovaquone with proguanil (Maloff Protect ®) Always speak to the pharmacist before buying the above malaria prevention medicines.
If you need any of the following malaria prevention medicines, you will need to obtain a private prescription and pay privately for their supply.
atovaquone with proguanil hydrochloride (Malarone®, Mafamoz®, Reprapog®) doxycycline mefloquine (Larium®) You can obtain a private prescription from your GP practice if they provide this service. Your GP practice may charge you for providing a private prescription. The level of charge applied is at the discretion of the GP practice. Ask your GP practice for information on any charges they may apply.
We offer a FREE TRAVEL ADVICE SERVICE. However, travel advice and clinics are also available elsewhere. There may be a charge for using these services.
Trailfinders Travel Clinic /The Royal Free Travel Clinic / The Royal Free Hospital
MASTA Travel Clinic / Oxford Circus Travel Clinic
Fit for Travel
(a service from NHS Scotland) /
Nomad Travel Clinic / City (London Underground Bank, Exit 1)
IMMUNISATION FOR FOREIGN TRAVEL
Fill in one form for EACH traveller
PLEASE NOTE, WE CANNOT ACCEPT FORMS UNLESS THE DATE OF DEPARTURE IS AT LEAST 2 WEEKS AFTER YOUR FIRST TRAVEL APPOINTMENT WITH US
SURNAME______FIRST NAMES______DATE OF BIRTH ______
ADDRESS______
Contact Number ______e-mail______
Which country/countries are you visiting?______
Which regions of that country are you visiting?______
What is your departure date______How long are you staying there?______
What stopover’s are you having and how long______
Please tick / 1. Type of Trip / Business / Pleasure / Other2. Holiday Type / Package / Self organised / Back Packing
Camping / Cruise Ship / Trekking
3. Accommodation / Hotel / Relative/family home / Other
4. Travelling / Alone / With family/friend / Group
5. Staying in area which is / Urban / Rural / At altitude
Planned activities / Safari / Adventure / Other
Please indicate which vaccines you have received previously and the date if known
Vaccine / Date / For PracticeVerification Only / If required, the costyou need to pay for vaccine / Payment received
TETANUS/POLIO/
DIPTHERIA (REVAXIS) / FREE / N/A
TYPHOID / FREE / N/A
RUBELLA / FREE / N/A
HEPATITIS A - 1st / FREE / N/A
HEPATITIS A - 2nd / FREE / N/A
HEPATITIS A & B combined / £50
MENINGITIS ACWY / £65
YELLOW FEVER / £60 for patients
£65 for patients not registered with us
HEPATITIS B - 1st / £50 per dose
HEPATITIS B - 2nd / £50 per dose
HEPATITIS B - 3rd / £50 per dose
CHOLERA
(PRESCRIPTION ONLY)
Contd on 2nd page
SURNAME______FIRST NAMES______DATE OF BIRTH ______
Do you have any medical problem requiring regular monitoring? / NO YESIf YES, what is the problem?
Are you taking steroids? / NO YES
Are you taking any other regular medicine? / NO YES
Are you pregnant, or trying to conceive? / NO YES
Have you reacted badly to any previous vaccine? / NO YES If YES, which
Are you allergic to any medicines? / NO YES if YES, which
I confirm the above answers to be correct to the best of my knowledge. I accept that the practice can only provide recommendations based on the above information and the information held in my patient records and that I am responsible for any changes to the itinerary made after my consultation.
On this basis I request immunisation and anti-malarial advice from my trip as outlined above.
PATIENT’S SIGNATURE______DATE______
(parent if under 16)
After you have submitted your form one of our nurses will call you to discuss your immunisations; if after one week you have not heard from us please call the surgery.