Online Travel Form

Travel Form
PLEASE COMPLETE A FORM FOR EACH PERSON TRAVELLING

Some vaccines are not covered by the NHS and will be charged for.
Vaccines requiring payment will not be given until payment is received.
More than one appointment may be required.
Some courses take a month or more to complete.
Please allow sufficient time before travel.

Please complete this form and return to reception for a nurse to fill in. After 7 days please collect form, read attached information and make an appointment.

WE CAN ONLY ACCEPT CASH OR CHEQUES (payable to Oak Tree Partnership)
PERSONAL DETAILS:
ITINERARY
Please tick the description that best describe your trip:
WOMEN ONLY:
PATIENT TO COMPLETE (IF UNKNOWN LEAVE BLANK)
Disease protection, Date of previous vaccines
Yellow Fever - Please contact Woodlands Surgery on 01235 517 760.

Japanese B Encephalitis - Please contact Masta Travel Clinic, Reading on 03301 004 292.

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