Please complete the sections below so we have the correct information about the countries you are visiting, the duration of travel and the type of travel you are undertaking.
Examples as below:
Thailand; Airbnb; 5/8/24-9/8/24; 5 days
Indonesia; Resort; 10/8/24- 12/8/24; 3 days
Please select that apply *
Please select that apply *
Planning to conceive within 3 months of return from travel? *
Personal or strong family history of leg or lung blood clots? *
Hospital admission in the last 3 months? *
Did you miss any of your childhood or scheduled vaccines?*
