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The Penylan Surgery | Meddygfa Penylan Providing NHS services
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Home > Travel Vaccination Form

Travel Vaccination Form

We only provide NHS funded vaccines. We may signpost you to a private clinic for other vaccines you may need. Please complete thus form at 4 to 6 weeks before travelling to allow vaccines to be effective. Late submissions may mean vaccines can not be offered.

All appointments for travel vaccinations are on Wednesdays.

Ideally to be completed by traveller prior to appointment.

Travel Vaccination Form
Please supply information about your trip in the sections below
Country 1
Country 2
Country 3
Further Info
Where are you staying?
Type of Travel and Purpose of Trip - Please tick all that apply
Please Supply Details of Your Personal Medical History
Medications
Previous Vaccines Taken
Please supply information on any vaccines or malaria tablets taken in the past
Additional Information

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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The Penylan Surgery | Meddygfa Penylan

72 - 74 Pen-Y-Lan Road | 72 - 74 Heol Pen-Y-Lan, Cardiff | Caerdydd, CF23 5SY

  • 029 2049 8181
© Neighbourhood Direct Ltd  2026
GP Practice Website by Oldroyd Publishing Group

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Local Services
Wills
& LPA
Ear Wax
Removal
Vet
Hearing Aids
& Services
Ultrasound
Scanning