Pivotal Health > Forms > Pre Travel Questionnaire

Pre Travel Questionnaire

To ensure your appointment for your pre travel consultation and vaccinations runs smoothly we ask that you download a copy of our Pre Travel Questionnaire and complete it before coming to the practice.

Click here to Download the Pivotal Health Pre Travel Questionnaire

or complete the online form below

Pre Travel Questionnaire

  • Pre Travel Questionnaire

    At Pivotal Health we are committed to providing our patients with the best possible care. It is highly recommended that you see a doctor before travelling overseas. To help us ensure that we have all of the right information for you at your pre travel appointment we ask that you complete the following information form and return to reception at your earliest convenience. Please note that you may require more than one appointment to discuss your pre travel health requirements.
  • AllergyType of Reaction 

  • Your Travel Plans

    Please complete the following details about your upcoming trip.
  • Date of DepartureDate of Return
  • CountryCity/RegionUrban/RuralAccomodation TypeDuration 

  • Vaccination History

  • We thank you for taking the time to complete the questionnaire, please click submit and the form will be sent through to our reception staff.

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