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 may not be able to offer an appointment for your vaccinations and there will be a consultation charge.)
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