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: 18 February 2026
  Show all updates

  1. 18 February 2026

     Updated form.

  2. 24 January 2024

     Updated form.

  3. 14 March 2022

     Updated form.

  4. 10 August 2020

     Added revised version of the request form.

  5. 30 October 2019

     Added new telephone number for Rabies and Immunoglobulin service.

  6. 21 May 2019

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

  7. 21 June 2018

     Updated form to accompany updated guidelines.

  8. 10 August 2017

     First published.

Applies to England and Wales

Documents

Pre-exposure rabies request form

MS Excel Spreadsheet, 118 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