Travel Vaccination | World Wise Travel Hamilton

Please fill out the form below to book your travel vaccinations

or phone us at: 07 839 7761

Who are you filling this form out for? (Please fill in a form for each individual)

Full Name

Date of Birth

Gender

New Zealand Address

City

Post Code

Cell Phone Number

Email

Where are you traveling to? (Please list all destinations)

How long are you traveling for?

Leaving Date

Return Date

List all planned activities during travel

Detail the purpose of the trip. (eg. visiting friends and relatives, work, holiday)

What previous vaccinations have you had?

Types of accommodation are you staying in?

Do you have any significant medical conditions?

Do you have any medical conditions that cause immunodeficiency?

Have you had any surgery in the last 6 months?

Any bleeding or clotting disorders?

Are you pregnant, breastfeeding or planning pregnancy?

Have you had a reaction to any previous vaccination before?

Address

FAQs

Mon to Thurs – 9am to 5pm
Friday – 9am to 4pm
Friday – NO IMMIGRATION SERVICES, Travel consultations only
Weekends – Closed

Inside Anglesea Pharmacy
Gate 1 or 2
Anglesea Pharmacy
Thackeray Street
HAMILTON

Contact