Pre-Travel Health Risk Assessment Form
Personal Information
Full Name
Date of Birth
Gender
Female
Male
Other
Prefer not to say
Contact Number
Email Address
Travel Details
Destination Country
Travel Dates
Purpose of Travel
Type of Accommodation
Medical History
Any current medical conditions?
Current medications
Known allergies
Vaccinations (list and date)
Travel Exposures
Planned activities (e.g., hiking, swimming, rural travel)
Any high-risk areas or concerns for your trip?