The Nelson Medical Practice

Kingston Road, London, SW20 8DA

111 Out of hours
GP services only, call: 020 3826 0826
All other Health Centre Services, call: 0203 668 3300

Travel Risk Assessment Form

Please complete the following form and submit it to the practice at least 4 weeks before your planned travel date.

A member of the nursing team will contact you to discuss your request and arrange an appointment for any required vaccinations.

Please write your name. For discussion when risk assessment is performed within your appointment. I have no reason to think that I might be pregnant. I have received information on the risks and benefits of the vaccines recommended and have had the opportunity to ask questions. I consent to the vaccines being given.