Print this Page

**ONLINE VACCINATION BOOKING**

Hajj & Umrah Travel Vaccination Clinic Booking Form 2014

Guidance Notes to completing the online booking form:

  • All fields are mandatory and required
  • Please complete in CAPITAL letters
  • One form to be completed per booking
  • Once completed, we will send you a pro-forma with a unique reference number. Upon full payment, your booking will be confirmed. See further notes below. For help or assistance please email us.
  • The clinic is open to anyone 2 years old and above (under 2’s to be seen by their GP’s)
  • Pre payment required to secure a booking, so please action any emails you receive promptly.
  • On the day – ensure you wear suitable baggy clothing to allow the vaccination to be administered to the top part of the arm (do not wear tight fitting clothes and be able to roll your sleeves up high)
  • ON COMPLETION OF THE FORM YOU WILL BE CONTACTED WITHIN 48 HOURS WITH A PRO-FORM ORDER, PLEASE CHECK YOUR EMAIL (&  JUNK FOLDERS) TO ACTION ANY REQUESTS.
  • Telephone or ‘on-the-day’ bookings will incur a £5 admin fee.
  • At peak times the telephone may take longer to answer or you may be diverted to a voicemail and may take upto 48hours for a response.  You are advised to email any queries for a faster response.
COSTS
  • ACWY VAX – 5yrs of age and above (inc adults)  £30 each (includes FREE vaccination certificate). 
  • Conjugate ACWY – 12months and above (inc Adults) £38 each (includes FREE vaccination certificate).
  • Hajj & Umrah Seminar ONLY – FREE to Attend
——————————————–

--------------------------------------------------------
PERSONAL DETAILS
--------------------------------------------------------

Title

Your full Name (SAME AS YOUR PASSPORT) (required)

Date of Birth (DD/MM/YYYY) (required)

Address(required)

Town/City(required)

Post Code(required)

Home Tel:(required)

Mobile Tel:(required)

Your Email (required)

--------------------------------------------------------
TRAVEL DETAILS - This will help us paint a picture of prices and also make contact with you to get key information relating to your group, umrah and hajj.
--------------------------------------------------------

Name of Tour Operator you have booked with: (required)

Date of Flight: (required)

Cost of Flight:

Departure Airport: (required)

Cost of Pilgrimage Package (price per person) excluding flight costs

--------------------------------------------------------
GP DETAILS - Only required if booking for vaccination.
--------------------------------------------------------

GP's Name:(required)

GP's Address & Postcode:(required)

--------------------------------------------------------
CLINIC DATES
--------------------------------------------------------

Select the clinic you'd like to attend (or leave blank if unsure) and we will contact you when we confirm venue - *=TBC (required) ***IF THERE IS A PROBLEM SELECTING THE CLINIC PICK ANOTHER ONE AND ENTER THE CORRECT DATE REQUIRED IN THE NOTES SECTION BELOW***

Select the Vaccine you require

--------------------------------------------------------
MEDICAL
--------------------------------------------------------

Do you suffer from Allergies?

Are you on any medication?

If you have answered Yes to any allergies or medication please list them in the box below or leave us a Message:

--------------------------------------------------------
HAJJ SHOP * PRE-ORDER & SAVE MONEY *
--------------------------------------------------------

 Mens Towelling Ihram (One Size) Budget £12.00 Mens Towelling Ihram (One Size) Premium Quality £15.00 TUBE IHRAM + free belt £27 Kids Towelling Ihram (One Size) Premium Quality £12.00 Hajj & Umrah Sanitary Pack £10.00 Hajj Safe - Travel Waist Bag (Anti-Theft RRP £12.99) £10.00 Hajj Guide Set of Books by IDA £4 CBHUK Branded Drawstring (shoe) Bag £2 CBHUK Branded Lanyard £1

——————————————–
Please note: By pressing the SEND button does not constitute a booking until full payment has been made and confirmed by us with a unique reference number. You will need to fill in one form per booking. Regreatfully we do not administer children under 2 years, you will need to see your own GP. We reserve the right to cancel a booking at anytime regardless of whether payment has been made or not without any reason whatseover. Full payment required which is non-refundable.
You also agree for us to contact you regarding a booking or for feedback and are happy to subscribe to the CBH email newsletter and alerts. Please email us if you do not wich to be sent any email communications.
(Please note the CBH does not share any personal information with any 3rd party and is strictly used in connection with products & services which you have signed up to and to facilitate the administration thereof.
——————————————–

Permanent link to this article: http://dobuy.co.uk/cbhuk/?page_id=847

Hide me
Sign up below to join our eNewsletter
join our mailing list * indicates required Email Address *
Show me
Build an optin email list in WordPress [Free Software]
Know Before You Go Foreign & Commonwealth Office | FCO National Health Service | NHS Health Protection Agency World Health Organisation Ministry of Hajj National Fraud Intelligence Bureau Met Police City of London Police ATOL Blackstone Publishers (UK) Hajj People CBHUK - Travel Clinics