Form

Rabies: pre-exposure request form

Request form for non-travel pre-exposure rabies vaccine.

• From: UK Health Security Agency
• Published: 10 August 2017
• Last updated: 24 January 2024 — See all updates

Applies to England and Wales

Documents

Pre-exposure rabies request form

Ref: Gateway number GOV-16070

MS Excel Spreadsheet, 94.5 KB

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Details

Please use this form in conjunction with the guidelines for requesting rabies pre-exposure prophylaxis.

Return the completed request form by secure email to PHE.ig.clerks@nhs.net

Published 10 August 2017
Last updated 24 January 2024 + show all updates

1. 24 January 2024

   Updated form.

2. 14 March 2022

   Updated form.

3. 10 August 2020

   Added revised version of the request form.

4. 30 October 2019

   Added new telephone number for Rabies and Immunoglobulin service.

5. 21 May 2019

   Added updated form (version 2) to accompany updated guidelines for requesting pre-exposure prophylaxis.

6. 21 June 2018

   Updated form to accompany updated guidelines.

7. 10 August 2017

   First published.