News:

The phone number at Bramhall Park will be changing in February 2010 to 426 9700

WE ARE NOW OFFERING THE SWINE FLU VACCINATION TO PATIENTS, PLEASE RING US TO MAKE AN APPOINTMENT IF YOU NORMALLY HAVE A SEASONAL FLU JAB

 

PLEASE BOOK IN FOR YOUR FLU JAB IF YOU NORMALLY HAVE ONE

National Flu Helpline 0800 1513 513

We are trialling a new SMS texting service which we hope to use to remind patients to attend for appointments.  If you would like to take part please contact Kath on 440 8981 or email kath.wilkinson@gp-p88016.nhs.uk

The Practice now opens every Saturday morning at Shaw Heath.  This service is for patients who work and cannot attend on weekdays

To book an advance appointment please click on the appointments section

The surgeries are both open from 8.15am until 6.30pm. After 6pm the telephones are transferred to voicemail where you can find details of our out of hours service

 

Travel Questionnaire

DR N J DEVINE AND PARTNERS
 
TRAVEL QUESTIONNAIRE    Private and Confidential 
Going Abroad on Holiday or Business? You may need travel vaccinations, depending on the country or countries that you intend to visit. To help us advise you on the protection you need, please see a Practice Nurse at least 6 weeks before you travel and ideally 12 weeks ahead. Allow at least 20 minutes per person travelling, for this interview.
 
When you have completed this questionnaire, return it to us as soon as possible and make that first appointment. (Please note: one form per traveller).
 
Name _________________________________________  Date of birth____________________
 
Address_______________________________________________________________________
 
_________________________________________ Tel.No. _____________________________
 
1. Which countries do you intend to visit (including brief stopovers)?______________________
 
______________________________________________________________________________
 
2. Will you be staying in hotels, with air conditioning/without air conditioning, or under more primitive conditions (e.g.camping)?
______________________________________________________________________________
 
3. Are you visiting friends or relatives? – YES / NO
 
4. Does your journey include:- Coastal areas _________      Inland areas __________
 
5. Do you plan any safaris, jungle exploration or travel in difficult terrain? ____________
 
6. Do you plan to be doing any sporting activities? – No________        Yes__________
  
    If yes, please specify __________________________________________________________
 
7. Departure Date ___________________
 
8. Duration of stay abroad ______________________
 
 
9. Have you ever had any of the following vaccinations and if so, when?
 
Rabies  ________________      Typhoid _______________      Tetanus __________________
 
Hepatitis A/B_____________   Yellow Fever ____________   
 
Childhood vaccinations, including polio and diphtheria _________________________________
 
                                                                                                            /continued overleaf
 
  Travel Questionnaire – page 2
 
 
10. Are you allergic to anything, including eggs/chicken? If yes, please give details
 
______________________________________________________________________________
 
______________________________________________________________________________
 
11. Are you on any medications, including steroids? If yes, please give details _______________
 
______________________________________________________________________________
 
______________________________________________________________________________
 
______________________________________________________________________________
 
 
12. Have you ever had or are you suffering from heart disease or other chronic illness? If yes, please give details:-
 
______________________________________________________________________________
 
______________________________________________________________________________
 
______________________________________________________________________________
 
13. Are you pregnant?   Yes           No
 
14. Have you ever had chemotherapy/radiotherapy or transplant surgery?__________________
 
_____________________________________________________________________________
 
15. Do you feel well today?     Yes            No
 
Remember, if you are receiving any medications, make sure that you take enough supplied to last through your overseas visit.
 
I confirm the above answers to be correct to the best of my knowledge and request vaccination as appropriate to my trip, along with travel advice and malaria advice if appropriate.
 
I also understand I must wait on the premises for 20minutes following vaccination, in case of a reaction occurring.
 
 
Patient’s signature __________________________________    Date ___________________
(Parent if under 16 years)