Please complete the following form to request vaccinations appropriate to your travel plans, together with advice on anti-malarial drugs.
Failure to complete the form correctly, and in full, may delay your vaccination programme.
Please give details of which countries and areas you are visiting,
Please state whether you have had the following immunisations.
Further info: certain anti-malarial tablets can, in a small percentage of people, exacerbate epilepsy or psychiatric illness.
Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
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