Rabies: pre-exposure request form

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


Pre-exposure rabies request form

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

Return the completed request form by secure email to

Published 10 August 2017
Last updated 30 October 2019 + show all updates
  1. Added new telephone number for Rabies and Immunoglobulin service.
  2. Added updated form (version 2) to accompany updated guidelines for requesting pre-exposure prophylaxis.
  3. Updated form to accompany updated guidelines.
  4. First published.