Risk Assessment

Vaccination RAF

Personal details
Trip details
Health info

About you

First Name

Last Name

Date of birth

Address

City

Post Code

Phone/Mobile

GP Surgery

Itinerary & purpose

What is the purpose of the vaccination?

Travel

Occupation

Other

Date of departure

Country to be visited

Personal health

Do you take any regular medicines?

Yes

Please provide details

Have you had any vaccine in the past 4 weeks?

Yes

Please provide details

Have you had a serious reaction to a vaccine, antimalarial or doxycycline before?

Yes

Please provide details

Do you or any of your family suffer from epilepsy?

Yes

Please provide details

Have you recently undergone radiotherapy, chemotherapy, steroids treatment?

Yes

Please provide details

Do you have history of black water fever, blood disorders (thalassemia or sickle cell anaemia), anxiety, depression, heart problem, lung problem, spleen, liver, kidney, taking immunosuppressive or chemotherapy, diabetes, HIV-AIDS or other medical conditions?

Yes

Please provide details

Do you have any allergies, particularly to eggs or chicken protein?

Yes

Please provide details

Are you pregnant (or planning a pregnancy) or breastfeeding?

Yes

Not applicable

Please provide details

Vaccination

Do you require Yellow Fever vaccine with this consultation?

Yes

How old are you?

Have you ever reacted to a previous yellow fever vaccine?

Yes

Please provide details

Do you have cancer or have you had cancer in the past (even if it was a long time ago)?

Yes

Please provide details

Do you have any illness that might affect your immune system?
For example, leukaemias, lymphoma, cellular immune deficiencies, chronic lymphoproliferative conditions, or if you have ever received a stem cell transplant.

Yes

Please provide details

Are you living with HIV?

Yes

Please provide details

Are you taking any medicines (now or within the last year) that affect your immune system?
For example, steroids, biological or non-biological immune modulating medicines, treatment following an organ transplant

Yes

Please provide details

Are you having chemotherapy or radiotherapy (now or within the last year)?

Yes

Please provide details

Have you ever been told that you may have a problem with your thymus gland (includes myasthenia gravis or a thymoma)?

Yes

Please provide details

Have you had an operation to remove your thymus gland (thymectomy) for any reason including during cardiac surgery?

Yes

Please provide details

Have you ever had open chest surgery?

Yes

Please provide details

Are you pregnant or planning a pregnancy?

Yes

Are you breast feeding?

Yes

Do you have a first-degree family relative (i.e. a blood relative – mother, father, full brother, sister or child) who has had a serious adverse reaction to yellow fever vaccine?

Yes

Please provide details

Past vaccination details

Consent

I consent to have this website store my submitted information so they can respond to my inquiry

I have read and agree to the Terms and Conditions and Privacy Policy

Prescription (official use only)

Travel essentials

Travel sickness

At our travel clinic, we also provide a range of other remedies and treatments to help with various health issues. This includes options for indigestion like Omeprazole, Lansoprazole, Gaviscon tablets, as well as treatments for cystitis such as Nitrofurantoin antibiotics and Sodium Citrate sachets. We also offer medications for diarrhoea, pain relief, and more.

* These antibiotics are for personal use outside of the UK only

Experiences Shared by Our Customers

Don’t simply rely on our claims, become part of the delighted community of thousands of customers who are experiencing the remarkable benefits!

Great online chemist, very easy to order and fast delivery.

Great website, easy to use. Also really quick delivery. Arrived within two days. Used this site before have had no problems. 👍

Ordered Inhaler on Monday, received next day, no problems whatsoever. Really pleased with the service. Will use again for sure!

Really great experience. Product at great price, easy to order, consult, fast delivery. I had to contact for delivery change and was handled brilliantly.

I would just like to take the time on behalf of myself and my family members to say and thank the wonderful staff at the pharmacy. They are so friendly and dedicated to helping you.

Friendly, reliable, brilliant ear wax removal service, worth the price! If you need ear wax removal, you'll definitely be able to hear again after using this service!

Lovely team at Online Chemist!! I went here for some travel vaccinations and they went very smoothly.

Helpful and friendly, had some vaccinations and never felt the needle!

Happy with the service. Used to get my daughters chickenpox vaccine. Would use again!

Staff were helpful and friendly when getting our travel vaccines. Managed to fit us in at short notice which I’m incredibly grateful for! Highly recommend and would use them again.

Absolutely fabulous helpful people. My doctor sent a prescription through for me late morning it arrived in afternoon. Thankyou so much. Highly recommended.

Staff went above and beyond to ensure that we were able to get travel vaccines at such short notice. Friendly staff. Thank you!

Online Chemist
82 Middleton Road
Gorleston
Great Yarmouth
Norfolk, NR31 7AH
Phone: 01493 600610
Email: info@onlinechemistuk.net

Superintendent Pharmacist:
Obaidullah Zaman
BPharm, MPharm, PGDip (Pharmacy), MRPharmS, IP
GPhC Reg. Number: 2083409

Pharmacy Premises GPhC Reg. Number: 9011159

Verify Approval for www.onlinechemistuk.net

OPENING HOURS

Monday 09:00 – 17:00
Tuesday 09:00 – 17:00
Wednesday 09:00 – 17:00
Thursday 09:00 – 17:00
Friday 09:00 – 17:00
Saturday Closed
Sunday Closed

Click here for driving directions

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OnlineChemist is a trading name of Nomaz Limited.
Registered in England – 11349276.