Submit your Pre-travel Assessment Form

No information submitted through this form is stored electronically. All information entered is saved as a PDF document and emailed to the clinic staff. Don't forget there are 3 tabs below so ensure you check each tab for relevant questions before submitting.

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To select multiple options, use the CNTL key when clicking on each selection.
To de-select an item, press CNTL key and click the selected item, this will un-highlight the item.

To select multiple options, use the CNTL key when clicking on each selection.
To de-select an item, press CNTL key and click the selected item, this will un-highlight the item.

Show dates of past vaccinations

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