If you are going to be traveling abroad and think that you may require travel vaccinations, please complete the online Travel Risk Assessment Form below, download the form by clicking the following link Travel risk assessment form.doc or alternatively you can request one from the surgery. Please complete ideally eight weeks before travel, but no later than four weeks before travel.We will then contact you to arrange an appointment with the travel nurse, normally approximately 6 weeks before you travel. We are unable to offer you an appointment if you contact us less than a month before your holiday.
What happens if I am traveling last minute?Our travel clinics are very popular and do become fully booked. Also, some vaccinations need to be administered in plenty of time for them to become truly effective and some require a course of injections
If you require vaccinations at short notice, a private travel clinic MAY be able to help, for example: Nomad Travel Clinic 38 Park Street Clifton Bristol Tel: 0117 922 6567 www.nomadtravel.co.uk
Have you ever had any of the following vaccinations / malaria tablets and if so when?
I have no reason to think that I might be pregnant and declare this information to be correct. I consent to the vaccines being given after discussion with the practice nurse.
Please be aware that there is a fee for certain vaccinations.
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 known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Burnham Medical Centre
Love Lane, Burnham-on-Sea, Somerset, TA8 1EU.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.