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For Patients

Travel Questionnaire

Please fill out our travel questionnaire and registration form before your appointment or arrive 15 minutes early to fill out our paperwork.

A separate form must be filled out for each individual traveling:

Pediatric travelers, under the age of 18 must fill out two forms:

Billing and Insurance

We accept cash, check, credit or debit card only with payment due at the time of services. Most insurances do not cover travel immunizations, however, if you would like to bill your insurance we can provide you with a receipt to submit to your insurance company. Medicare does not cover travel medicine.

Prior to providing services we will ask you to complete a disclosure form indicating that you understand travel medicine is most likely not covered by your insurance.

Patient Authorization

Prior to treating you for travel we will need you to fill out an authorization form. We cannot treat you without proper documentation.