8 Loy Street | Cookstown | County Tyrone | BT80 8PE

Travel Health Questionnaire

Travel Health Questionnaire

To help us offer the appropriate advice, please fill out the online form below before coming to see the nurse.

Travel Risk Assessment Form

Personal Information


Please supply information about your trip in the sections below:


Type of travel and purpose of trip


Details of Your Medical History


Vaccination Details


Clinical Services Notice

This is an example of a notice that can be displayed with on your Clinical Services page. Notices can be scheduled both for publication and deletion. Notices in this section are organised in descending date order with the most recent notice at the top. Notices are limited to no more than 100 words. You can have a maximum of 6 of any page.