Travel Health Assessment Form


Personal Information
Travel Itinerary
Purpose of Travel
Medical Conditions
Activities Planned
Areas of Travel
Health History
Allergies
Immunization
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|


List all current medications (prescription, non-prescription, herbal and vitamins)
For women only

Common Risks and Diseases for Travelers

Hepatitis B is a viral liver disease acquired through contact with contaminated blood or other body fluids.  Travelers may become infected though contaminated tools and equipment used in medical or dental procedures, or by receiving infected blood products.  Engaging in activities such as tattooing, acupuncture, injection drug use and unprotected sex will also significantly increase the risk of infection.  All unvaccinated travelers are recommended to receive hepatitis B vaccine even if they did not intend to engage in high risk activities.  This is especially true for those who plan to travel to Asia or Africa, where hepatitis B is common.  

Hepatitis B vaccine usually consists of 3 doses administered at 0, 1, and 6  months.  Although the first 1 to 2 doses can provide some protection, it is highly recommended to receive the full 3-dose series to achieve optimal protection.

Typhoid fever is a potentially serious bacterial infection that is usually transmitted through consumption of contaminated food and water.  Each year an estimated 22 million cases and 200 000 related deaths occur globally.  Travelers visiting South Asia is at highest risk; other risk areas include East and Southeast Asia, Africa, Caribbean, Central and South America.  Two kinds of vaccine are available to protect travelers from typhoid fever.  While they are not 100% effective, people traveling to risk areas are strongly recommended to be vaccinated, especially for long-term travelers or those staying with or visiting friends and relatives.  Since vaccines do not provide 100% protection, it is important for travelers to be cautious and take steps in preventing consumption of contaminated food and water.

Hepatitis A is a viral liver disease usually acquired through ingestion of contaminated food or water.  It occurs throughout the world and is most common in developing countries, especially in Central and South America, Africa, Middle East, Asia and Western Pacific.  International travelers are at increased risk, particularly for those who travel to high-risk countries, visit rural areas, or trek in backcountry areas.  It is preventable by receiving hepatitis A vaccine before travel.


Services



  • E-Prescription

  • Semi Transparent Header
  • Travel Health

  • Semi Transparent Header
  • Vaccination Clinic

  • Flu shot