Somerville Medical Centre

69 Gorsey Lane, Wallasey, Merseyside, CH44 4AA

Current time is 21:45 - Sorry, we're closed

Telephone: 0151 638 9333

wiccg.gatekeeperN85024@nhs.net

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Pre-Travel Information

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Pre-Travel Information

Pre-Travel Information

Before foreign travel it is always best to check if you need any extra vaccinations. You can do this by completing the form below, which will then be given to our specially trained Practice Nurses.

Holiday vaccinations are a 30 minute appointment at our surgery. We recommend that vaccinations are given at least two weeks prior to travel.

For more information please visit www.smarter-traveller.co.uk or www.fitfortravel.nhs.uk.

Pre-Travel Vaccination Form

Full Name*
First Last
Date of birth*
MM slash DD slash YYYY
Contact number:*
Do you have any allergies?*
If yes please specify
Have you ever experienced a reaction to a vaccine?*
If yes please specify
Have you ever undergone any surgery?*
If yes please specify
Have you ever had chemotherapy/radiotherapy?*
Have you ever had an organ transplant?*
Do you suffer with any medical conditions?*
If yes please specify
Do you take any medication (prescription/bought over the counter)?*
If yes please specify
Are you currently pregnant/breastfeeding?*
Please give any details of your vaccination history:
Date of departure*
MM slash DD slash YYYY
Date of return*
MM slash DD slash YYYY
Destination(s), Please specify if you are staying in a city/rural location*
Type of travel*
Purpose of travel*
Name
This field is for validation purposes and should be left unchanged.

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Opening Times

Monday
08:00 until 18:30
Tuesday
08:00 until 18:30
Wednesday
08:00 until 18:30
Thursday
08:00 until 18:30
Friday
08:00 until 18:30
Saturday
CLOSED
Sunday
CLOSED

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