Request an appointment

Our Liverpool clinic operates a pre-travel drop-in clinic Monday to Friday 08:45 - 11:30. You can attend without an appointment, for travel health, vaccines, malaria tablets and occupational blood tests.

Please note upon occasion we reserve the right to close the drop in clinic early should demand for the service be very high.

You can request an appointment by calling 0151 705 3223 or by completing this form. Submitting this form is not a confirmation of appointment. Please wait to hear back from us.

If you require an urgent appointment (within 7 days), we recommend using our Liverpool walk in service, details above.

If your appointment date/time is unavailable we will book you into the NEXT SUITABLE SLOT and email you appointment confirmation.

This form is for requesting an appointment for a travel consultation, a Mantoux test or BCG, or for a specific vaccine. If you require a pre-travel medical for work purposes or any other occupational health service, please visit our Occupational Health pages.

Currently, a form needs to be submitted for each person attending. We are working on streamlining this process.

Here at Well Travelled Clinics we take your privacy seriously and will only use your personal information to provide the services you have requested from us. Before completing this form please take a moment to read our privacy policy in full.

Personal details

First Name *

Surname *

Date of birth *

Day

Month

Year

Age *

Contact number *

Email address (please double check this is correct before submitting) *

Have you been to one of our clinics before? *

Yes

Approximately when? *

Day

Month

Year

Your appointment

Please select all reasons that apply to your appointment. Select travel also if travelling. *

Travel consultation, Travel vaccines, Anti-malarial tablets

Mantoux Test or BCG vaccine

Other special vaccine request (Rabies & Non-travel)

Travel consultation, Travel vaccines, Anti-malarial tablets

Date of departure *

Day

Month

Year

Countries you are visiting (please list all) *

Duration of trip *

Type of activities/holiday *

e.g. package holiday, trekking, jungle, high altitude, back-packing.

Mantoux/BCG request

Mantoux testing clinics are held on a Tuesday afternoon at the Liverpool Clinic by appointment only. You would then need to return 48 hours later for the Mantoux test result.

Why do you require tuberculosis testing/BCG? *

UK based occupation

Occupation based abroad

You are a new entrant to the UK from a country with a high incidence of TB, or have had contact with patients in settings of high TB prevalence

Travel Purposes (please complete travel consultation section)

Please specify occupation *

Please specify occupation & country *

Have you had a BCG vaccinisation previously? *

Yes

Reason for request or other special vaccine (Rabies & Non-travel)

If you require a specific vaccine that is either non-stock or unlicensed, please indicate below and complete 'Reason/other' also: *

Reason for request/other vaccine

Rabies

Gardasil 9

Varicella

Meningitis B (Bexsero)

Tick Borne Encephalitis

REPEVAX diphtheria, tetanus, polio & pertussis (whooping cough)

Reason and vaccine: *

Medical History

For women only:

Are you pregnant/trying to get pregnant or breastfeeding?

Yes

Appointment information

Which branch would you like to be seen in? Please check opening hours before proceeding *

Liverpool

Chester

Liverpool - Appointments are currently available Monday to Friday from 2pm until 15:20 and Saturday mornings 09:00 - 12:00

LIVERPOOL Preferred appointment date? (This is not confirmed until you hear from us)

If you require an urgent appointment please call us on 0151 705 3223 to check availability

Day

Month

Year

Chester – Appointments are currently available Wednesday, Thursday, Friday 09:00 to 15:30 (closed for lunch 1pm to 2pm) and some Saturday mornings 09:00-13:00

CHESTER Preferred appointment date? (This is not confirmed until you hear from us)

If you require an urgent appointment please call us on 0151 705 3223 to check availability

Day

Month

Year

Chester AM/PM preference

Please select whether you prefer your appointment to be in the morning or afternoon of your appointment date

Names of people who have submitted an appointment request who you would like to book in with

Any other information?

Leave this field blank

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