If you are planning on travelling overseas, we strongly suggest you make an appointment with your doctor to discuss which travel vaccinations may be required for your trip.

Pre-Travel Assessment Form

To help your doctor assess your needs and your medical situation, we suggest you download and complete the Pre-Travel Assessment Form before your appointment.

Download the Word Document

or

Download the PDF

Instructions

The completed Pre-Travel Assessment form may be emailed or faxed to the East Perth Medical Centre.

Please also provide your appointment date and time when returning your Pre-Travel Assessment form.

1. Emailing your document:

Click on the form link and enter your patient details onto the Pre-Travel Assessment form. Save the document onto your computer and send an email with the form attached to:

2. Faxing your document:

Click on the form link and print the Pre-Travel Assessment form. Complete the form and fax to:

Fax: (08) 9221 3916

Please contact us if you have and questions on how to complete the form.