Women only Are you currently pregnant or breastfeeding? …………………………………….. Please list any current medical conditions Please list any current medication you take Please list any known allergies/previous reactions to vaccines OFFICE USE ONLY Vaccines required Malaria tablets required
Women only Are you currently pregnant or breastfeeding? …………………………………….. Please list any current medical conditions Please list any current medication you take Please list any known allergies/previous reactions to vaccines OFFICE USE ONLY Vaccines required Malaria tablets required
Sandown%20Health%20Centre%20Travel%20Clinic%20Questionnaire.docx