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HW+ Health and Wellbeing Plus | Travel Vaccines

Travel Risk Assessment

This form is a requirement for any medical procedure undertaken

Please complete this online form before your booked appointment

Our nurse practitioner will go through this form with you at your initial consultation before proceeding with any medical service required

Travel Risk Assessment Form

Please indicate the type of appointment booked

If you have booked a Couple or Family Appointment, complete and submit this form. Return to the same link and complete a separate form for each person.

Personal Details

Travel Details

Travel Insurance - Does it cover pre-existing conditions and planned activities?
Yes
No

Medical History

Please give brief details if any of the following are applicable, if not, please enter N/A

I confirm the information provided above is correct
Yes
No

Click Next, skip Page 2 and on Page 3 sign, date and submit your form

HW+ Health and Wellbeing Plus | Canterbury Clinic
Health & Wellbeing Plus

31 Saint George's Place

Canterbury

CT1 1UT

Email our Reception Team 

© 2006-2025 Health & Wellbeing Plus. All rights reserved.

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