Travel Clinic

Pre-Travel Assessment

Tell us about your health and your journey before your appointment, so your consultation can focus on what matters most for your trip.

Takes about 5–8 minutes

Confidential & secure

No obligation to book

1. About You

Full Name

This field is required.

Date of Birth

Format: DD/MM/YYYY

This field is required.

Email Address

This field is required.

Contact Phone Number

This field is required.

2. Your Trip

Destination Country / Countries

This field is required.

Specific regions or cities being visited (if known)

Departure Date

Format: DD/MM/YYYY

This field is required.

Return Date

Format: DD/MM/YYYY

This field is required.

Type of travel / planned activities (select all that apply)

City stay

Rural or village travel

Trekking / hiking

Safari / wildlife

Cruise

Backpacking

Extended stay / living abroad

Other

3. Your Health

Do you have any existing medical conditions? If yes, please list them.

Optional — you're welcome to discuss this with your doctor in person instead.

Are you currently taking any regular medication? If yes, please list.

Do you have any known allergies (medication, food, or other)?

Have you had any reactions to vaccinations in the past?

4. Vaccination History

Please list any travel vaccinations you’ve had before, and roughly when, if known.

5. Before You Go

If yes, please give their ages

Anything else you’d like your doctor to know before your consultation?

You submit your assessment

You’ll receive a reference number on screen — keep a note of it.

Our team reviews it

Your Family Doctor looks over your details ahead of your visit.

We’re in touch

We’ll contact you to arrange or confirm your Travel Clinic appointment.