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CLINTON SURGERY TRAVEL ASSESSMENT FORM (updated 04/15) IMPORTANT PLEASE BRING THIS COMPLETED FORM WITH YOU TO YOUR APPOINTMENT OR WE MAYN OT BE ABLE TO COMPLETE THE CONSULTATION.NAME Date of Birth:
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How to fill out colinton surgery travel assessment

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How to fill out colinton surgery travel assessment

01
To fill out the Colinton Surgery travel assessment form, follow these steps:
02
Download the travel assessment form from the Colinton Surgery website or obtain a copy from the reception desk at the clinic.
03
Read the form carefully and provide all the required information.
04
Start by filling out your personal details, including your full name, date of birth, and contact information.
05
Provide details about your upcoming travel, such as the destination(s), duration of the trip, and purpose of travel.
06
If you have any pre-existing medical conditions or take medications regularly, make sure to mention them accurately.
07
Answer all the questions regarding your health status, vaccination history, and any recent illnesses or surgeries.
08
If you are pregnant or planning a pregnancy, indicate it on the form.
09
If you have any specific concerns or requirements related to your travel, mention them in the section provided.
10
Review the form to ensure all the information is accurate and complete.
11
Submit the filled-out form to the reception desk at Colinton Surgery.
12
Wait for further instructions or contact the clinic if you have any queries.
13
Note: It is advisable to complete the travel assessment well in advance of your departure date to allow for any necessary vaccinations or medical advice.

Who needs colinton surgery travel assessment?

01
Anyone who is planning to travel and requires medical advice or vaccinations may need to fill out the Colinton Surgery travel assessment form.
02
This assessment form helps the healthcare professionals at Colinton Surgery to evaluate the individual's health status, provide appropriate medical advice, and administer necessary vaccinations to ensure a safe and healthy trip.
03
It is particularly important for individuals traveling to certain destinations or engaging in activities that may pose specific health risks, such as tropical regions or adventure tourism.
04
The travel assessment form also helps individuals with pre-existing medical conditions or special requirements to receive personalized medical advice and ensure their well-being during the trip.
05
It is recommended to check with Colinton Surgery or consult a healthcare professional to determine if filling out the travel assessment form is necessary for your specific travel plans.

What is COLINTON SURGERY TRAVEL ASSESSMENT (updated 04/15) Form?

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Template COLINTON SURGERY TRAVEL ASSESSMENT (updated 04/15) instructions

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Colinton Surgery Travel Assessment is a form to assess the travel history and potential health risks of patients visiting the Colinton Surgery.
All patients visiting the Colinton Surgery are required to fill out the travel assessment form.
Patients can fill out the travel assessment form at the reception desk of the Colinton Surgery or online through their patient portal.
The purpose of the travel assessment is to identify any potential health risks or exposure to infectious diseases based on the patient's travel history.
Information such as recent travel destinations, dates of travel, mode of transport, possible exposure to sick individuals, and any symptoms experienced must be reported on the travel assessment form.
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