Form

Rabies: pre-exposure request form

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

Applies to England and Wales

Documents

Pre-exposure rabies request form

Request an accessible format.
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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 [email protected]

Updates to this page

Published 10 August 2017
Last updated 24 January 2024 + show all updates
  1. Updated form.

  2. Updated form.

  3. Added revised version of the request form.

  4. Added new telephone number for Rabies and Immunoglobulin service.

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

  6. Updated form to accompany updated guidelines.

  7. First published.

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