Complete Your Travel Health Form

Help us tailor your consultation by sharing a few details about your trip. The more we know upfront, the better we can prepare to keep you safe and well overseas.

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Name Email Phone Date of Birth Ethnicity Gender Residency Status Address Line 1 Address Line 2City Next of Kin Name Next of Kin Phone Travel Date of Depature Country or Countries Visiting Rural or Urban Travel Risk Activities Mode of Travel Likely Access to Health Service Reason for Travel Independent Travel or Package Tour Accommodation Type Any Animal Interaction Anticipated Any Existing Medical Conditions Are You Up To Date with Routine Vaccinations Have You Had Travel Vaccines in The Past Current Medications Allergies Upload Vaccination Record (Optional) I certify that the information provided is correct

Please don’t include urgent medical information here. For emergencies call 111.

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Here 7 days a week. Ngā mihi, from all of us at 1 Health.

Enrol with our GP clinic Book an appointment Call 03 662 9309