Short Term Screening

Please complete the following STS form within 1 week of receiving it. Please give as much detail as possible, including dates and duration of any illnesses, hospital admissions, any other disorders etc. There are sections of the form where you can upload supporting documents. If you need to present any further documents on completion of the form, please send these to

Your response to this form will be processed by one of the specialist Travel Health nurses at Nomad and information will be stored confidentially & securely. The Nurse may occasionally need to liaise with other Nomad clinicians such as Doctors and Psychologists to determine the outcome of your STS. This form is confidential within Nomad and will not be shared with your organisation. Sometimes organisations request information, but this would only be shared with your permission.

Please ensure that you give full and careful answers to ALL questions that are relevant to you, to avoid delay in giving you your health screening outcome. Please note that Nomad cannot take any responsibility for illnesses, which either arise or worsen overseas, from conditions that are not declared on this form. In addition, there are health risks involved in travelling overseas which cannot always be avoided or prevented. If you have any significant changes to your health AFTER completing this form, please contact Nomad directly by emailing