Pre-Travel Assessment form

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


Download the PDF


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:

East Perth Medical Centre

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.