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When you make an appointment with our Travel Clinic, you’ll have the opportunity to meet one-on-one with your neighborhood pharmacist, who will work with you to create a customized travel plan. As part of your appointment, you’ll receive a packet of personalized information about where you’re going and the potential health risks, all with your health history in mind.

Before your appointment, you’ll fill out a questionnaire detailing your travel plans, prior vaccination history, current medication history, and other relevant health information. This is important to help you stay healthy while traveling. All decisions are based on the latest CDC guidelines, as well as, information on your travel destination that is current to the date of your appointment.

  • Traveler

  • Prescription, non-prescription (OTC) medications and/or supplements:
  • Past Immunizations

  • Which of the following vaccines have you received in the past? Please fill out this section to the best of your ability, as this information is very important for your Travel Clinic appointment.
  • Past Travel Medical History

  • If yes, list dates and locations of recent visits:
  • Itinerary

    List, in order, the countries you plan to visit. Please include LAYOVER countries and cities even if you will not be leaving the airport. Indicate the date of arrival and departure.

  • Trip Information

  • Additional Fields

  • I understand the benefits and risks of vaccines, and I authorize the Pharmacist identified below to administer it to me. I do not hold the authorizing Physician or the Pharmacist responsible for any adverse reaction. I understand it is recommended that I remain at the pharmacy for 10 – 15 minutes after the vaccination(s) in case of severe immediate reaction. A consultation fee will be charged, as well as the cost of any medications (or copay if insurance is billed) and/or vaccines you may be prescribed during your appointment. If your insurance does not cover the claim, you will be billed.


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