Mon - Fri: 9am - 7pm Sat: 9am - 6pm

   020 8654 1149  215 Lower Addiscombe Rd, Croydon CR0 6RB

Travel Health Assessment

Please complete this questionnaire before your consultation so our pharmacist can review your travel plans and recommend the most appropriate vaccinations, medications, and travel health advice for your trip.

*This is a private prescribing service. Consultation and treatment fees may apply.

Larchwood Pharmacy, Croydon

How Our Private Assessment Works

1. Book Your Travel Consultation

Arrange an appointment at Larchwood Pharmacy in Croydon before your departure date.

2. Personal Travel Health Assessment

During your private consultation, we review your travel itinerary, vaccination history and medical background.

3. Receive Vaccinations & Advice

If appropriate, vaccinations or malaria prevention will be provided, along with clear aftercare and travel guidance.

Travel Health Questionnaire

Travel Health Screening Questionnaire

Please complete this form so our pharmacist can assess your travel plans and recommend the appropriate vaccinations, medications, and health advice for your trip.

Personal Details

Please provide accurate personal details. This information allows us to verify your identity, assess vaccination suitability and communicate safely regarding your treatment.

All information is handled confidentially in accordance with UK data protection regulations.

Travel Details

Medical History

Please select any conditions that apply to you, past or present. This helps our pharmacist understand your overall health.

Current Medication

Allergies

Vaccination History

Pregnancy & Reproductive Health

These questions help us understand whether treatment is appropriate based on your current or planned pregnancy status.

Informed Consent

I confirm that the information provided is accurate and complete.

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