Home › Our Services › Travel Vaccinations › Pre-Consultation Form

Travel Vaccine Pre-Consultation Form

Complete this form before your appointment so we can prepare personalised advice and have everything ready for your consult.

ℹ️

Before you start

This form takes about 5 minutes to complete. The more detail you provide, the more tailored your consultation will be. You should have already booked an appointment — if not, call us on (01) 840 5940 first.

✅ Form received — thank you!

We have your pre-consultation details and will have everything prepared for your appointment. If you have any questions in the meantime, call us on (01) 840 5940.

Your details
Travel vaccines are open to non-patients.
Group travel
Group discounts apply for 2+ travelling together on the same trip.
Trip details
List all countries you will visit, even briefly.
Planned activities

Tick all that apply — this helps us assess your specific risk profile.

Previous vaccinations

Tick any vaccines you have received previously and enter the approximate year of your last dose. This helps us determine whether you are still protected or due a booster.

An approximate year is fine — check your vaccine booklet if you have it and bring it to your appointment.

Had it?
Vaccine
Approx. year of last dose
How long it usually lasts
Hepatitis A
Lifelong after 2 doses1st dose gives ~1 year protection. A booster at 6–12 months gives lifelong immunity. If you only had 1 dose and it was >1 year ago, you may need a booster.
Hepatitis B
Lifelong (full course)Full course = 3 doses over 6 months. If you completed the full course, immunity is generally lifelong. Partial courses may not be protective.
Yellow Fever
Lifelong (single dose)Since 2016, a single dose is considered to give lifelong protection. Your Yellow Fever Certificate (Carte Jaune) is valid for life from 10 days after vaccination.
Typhoid
3 years (injectable)The injectable typhoid vaccine (Vi polysaccharide) lasts approximately 3 years. A booster is recommended if you are travelling again and it has been 3+ years since your last dose.
Tetanus / Diphtheria / Polio
10 yearsA booster is recommended every 10 years, particularly for travel to areas with limited healthcare. If you had a tetanus injection after an injury, that counts as a booster.
Meningitis ACYW-135
~5 yearsThe conjugate MenACWY vaccine gives approximately 5 years of protection. Boosters are recommended for ongoing travel to high-risk areas (sub-Saharan Africa, Hajj pilgrims).
Rabies
VariablePre-exposure course = 3 doses. Even with prior vaccination, prompt medical attention is still required after any animal bite. If you travel frequently to high-risk areas, periodic antibody titre checks may be recommended.
Japanese Encephalitis
~1–2 years initiallyPrimary course = 2 doses. A booster is recommended after 12–24 months for ongoing risk. Longer-term protection with further boosters.
MMR (Measles / Mumps / Rubella)
Lifelong (2 doses)Two doses of MMR are considered to give lifelong immunity. Most people born before 1978 in Ireland had natural measles and are immune. If you are unsure whether you received 2 doses, let us know.
Cholera / Dukoral
2 yearsDukoral (oral cholera / ETEC) provides approximately 2 years' protection against cholera and some traveller's diarrhoea. Booster doses are needed if travelling again after 2 years.
Medical history & medications

This information is confidential and helps us ensure vaccines are safe for you.

Malaria risk
Common risk areas include sub-Saharan Africa, parts of South / South-East Asia, and Central America. Use FitForTravel to check your destination.
Anything else

Your information is treated in strict confidence and used only to prepare your consultation. See our Privacy Policy.

Your appointment

Haven't booked yet? Call or email us to arrange your consultation first, then complete this form.

📞
✉️
🕐
Opening hours
Mon – Fri: 8:30 am – 5:00 pm

Please book at least 6–8 weeks before travel — some vaccines need multiple doses.

General travel health tips

Vaccines are just one part of staying healthy abroad. Remember:

  • Insect bites — use DEET repellent (50%+), sleep under a treated net in risk areas, cover up at dusk and dawn.
  • Food & water — boil or bottle water in high-risk areas, avoid ice, raw salads, and shellfish. "Boil it, cook it, peel it or forget it."
  • Sun & heat — SPF 50+, stay hydrated, avoid peak midday sun in tropical climates.
  • Travel insurance — ensure your policy covers medical evacuation and the activities you plan. Do not travel without it.
  • EHIC / emergency card — bring your European Health Insurance Card if travelling within the EU.
  • Medications abroad — carry a letter from your GP if bringing prescription medications, especially controlled drugs.
Fit for Travel
The NHS FitForTravel destination checker is an excellent resource to see country-specific health risks before your appointment.
Yellow Fever Certificate
Some countries require proof of Yellow Fever vaccination to enter. We issue official Yellow Fever Certificates. Let us know at booking if this is required for your destination.