Travel risk assessment

For example, 15 3 1984
For example, 15 3 1984
Include which countries you are visiting, the exact location or region, city or rural, and the length of stay in each location
Have you taken out travel insurance for this trip?
Do you plan to travel abroad again in the future?
What is the type and purpose your trip?
Are you fit and well today?
Do you have any allergies?
For example, food, latex, medication
Have you or anyone in your family ever had a severe reaction to a vaccine or malaria medication?
Do you have a tendency to faint with injections?
Have you had any surgical operations in the past?
For example, open heart surgery, your spleen or thymus gland removed
Have you recently undergone chemotherapy, radiotherapy or had an organ transplant?
Do you have anaemia?
Do you have any bleeding or clotting disorders?
For example, a history of DVT
Do you have a heart disease?
For example, angina, high blood pressure
Do you have diabetes?
Do you have any additional needs or disabilities?
Do you or a first degree relative have epilepsy or seizures?
Do you have gastrointestinal complaints?
Problems with your stomach
Do you have liver and or kidney problems?
Do you have HIV or AIDS?
Do you have an immune system condition?
For example, blood cancer
Do you have any mental health issues?
For example, anxiety, depression
Do you have a neurological illness?
Problems with your nervous system
Do you have a respiratory disease?
Problems with your lungs
Do you have any rheumatology conditions?
Problems with your joints
Do you have any spleen problems?
Do you have any other conditions?
Are you or your partner pregnant are planning a pregnancy?
Are you breastfeeding?
Have you or anyone in your family undergone FGM, been cut or circumcised?
Are you currently taking any medication?
For example, prescribed, purchased or a contraceptive pill
Which vaccinations or tablets have you had in the past?
For example, dates administered and type
Do you have any additional information to provide?
Terms and conditions