travelTravel is so easy now that we often forget the risks. It’s important to make sure you have the appropriate health insurance cover for your trip, including if you’re travelling in the EU, obtaining your free EHIC (European Health Insurance Card). Vaccinations are strongly advised and in some cases obligatory when travelling to regions where diseases such as malaria, yellow fever, hepatitis C and polio are prevalent.

Different regions around the world have different risks, and making sure you have the correct immunisation before travelling is a must. Our guide to Vaccinations gives a good indication as to which diseases are currently preventable by pre-travel immunsation.

Other areas to consider when travelling include sun protection, how to prevent deep vein thrombosis (DVT) on long-haul flights, as well as travelling when you are pregnant.  Travelling when living with a condition such as cancer or diabetes may also require additional management.

You can find more information about travel health here:  Travel Health

Confidential Travel Health Questionnaire

If you are travelling abroad, you may need travel vaccinations and health advice regarding your trip. To help us give you the right advice, please complete this questionnaire. Please call reception 48 hours after you have completed the questionnaire.

Please contact us if you’re travelling within two weeks. Normally we like to see patients 6-8 weeks prior to travel, as sometimes more than one appointment is required.

All fields are to be completed.

Your Name

Date of Birth

Your Email

Contact Telephone Number


Intended Date of Departure

Duration of Stay

Which countries do you intend to visit?

Please list in sequence and include stopovers. Be specific about the areas you are visiting, especially if you are travelling to many countries and/or will be away for more than a month.

If you have a travel itinerary please upload it here:

What type of accommodation will you be staying in?

Will you be visiting Inland or Coastal areas?

Are you visiting friends or relatives?

Do you plan any:
SafarisJungle explorationOverland trekkingTravel in difficult terrainUnderwater activitiesOther
Other please specify:
Tick all that apply.

Have you had any of the following vaccinations and if so WHEN?





Hepatitis A

Hepatitis B


Yellow fever


Meningococcal ACWY

Other, please specify:

Are you allergic to anything?

If YES, please specify:

Are you breastfeeding?

Are you currently taking any medication?

If YES, please specify:

By clicking "Submit" you agree to medical staff at The Groves Medical Centre, New Malden, viewing your details for making a qualified assessment. We aim to have your results within 48 hours of submission.

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About The Groves – Private Medical Services

The Groves is unique in the range and quality of services we provide here, including the full range of diagnostic services from blood analysis and onsite mammography, right through to MRI scans, an onsite pharmacy, and, in addition, more than 60 specialist practitioners who provide consultations and a wide range of treatments at The Groves. Our aim wherever possible is to diagnose and treat of all your health needs in a single visit.

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