Please complete this questionnaire if you wish to book an appointment with the Travel Clinic.
You must complete a separate form for all travellers.
Please ensure that you disclose your past medical history and current medical conditions to ensure that we can make a full risk assessment and evaluation of your needs.
(Note, if you are completing this form within 8 weeks of your departure date we will NOT be able to offer an appointment for your vaccinations)
Workplace Wellness is the trading name of Bradford on Avon Occupational Health Services Ltd.
Registered in England: 9749251
VAT no. 27144823278
Registered Office: 29 Bridge Street Bradford on Avon Wiltshire BA15 1BY
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