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Travel Clinic Enquiry Form

Remember to request your vaccine history from your GP surgery. You can upload the file or an image of it below. 

Preferred Pharmacy
Birthday
Areyou allergic to the following, please select all that apply.
Are you pregnant?
Yes
NO
Unknown
Not applicable
Are you breastfeeding?
Type of trip (please select all that apply)
Area to be visited
Type and condition of accommodation
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