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Loggerheads - Travel Clinic (Pre-Consultation)
Our travel vaccination pharmacists will take you through a consultation to establish your vaccination needs and requirements.
This service is for Adults (18+) Only.
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First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Contact Number
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Your answer
Date Of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Travel Destination
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Your answer
Vaccines
*
Initial Vaccine Assessment
Cholera
Diphtheria, Tetanus & Polio
Hepatitis A (Adult)
Hepatitis B (Adult)
Hepatitis A & B (Adult)
Hepatitis A (Paeds)
Japanese Encephalitis
Measles, Mumps & Rubella
Meningitis ACYW
Rabies
Typhoid
Yellow Fever (+ certificate)
Chickenpox
Hepatitis B (Paeds)
HPV Vaccine
Pneumonia
Other:
Required
Vaccination History
*
Mention all past Travel Vaccination History. Separate with commas.
Your answer
Known Allergies and Existing Medications
*
Mention all known Allergies and existing Medications. Separate with commas.
Your answer
Service Consent according to the Terms & Conditions (https://www.loggerheads-pharmacy.co.uk/terms-and-condition)
Information recorded in this service will be lawfully shared.
(https://www.loggerheads-pharmacy.co.uk/privacy-policy)
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