Travel Health Risk Assessment
Full Name
Date of Birth
Nationality
Destination Country/Countries
Date of Departure
Date of Return
Purpose of Travel
Business
Leisure
Visiting Friends/Family
Other
Duration of Stay (in days)
Type of Accommodation
Hotel
Hostel
Homestay
Camping
Other
Pre-existing Medical Conditions
Current Medications
Vaccination History
Allergies
Emergency Contact Information
Additional Notes / Concerns