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Personal Details

Private Happy Vaccs Travel Vaccination Clinic: If you are not registered with Lambgates Health Centre and would like to use our Happy Vaccs Travel Clinic please complete the below travel vaccination assesment form, this will also create a temporary registration status for you at our pracitce. We will require a copy of your immunisation history, please email this to (please ensure your name, DOB and ' Travel Vaccination Clinic' is clearly stated on your email. 

Please double check you've entered the correct email address
Dates and Trip Details
Personal Medical History
Including diabetes, heart or lung conditions
Signed & Dated
Type your full name to sign this form

This form is automatically dated upon submission.

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.


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