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Travel Vaccinations


If you are traveling abroad, your destination may require that you receive a vaccine or medicine to prevent harmful viruses and diseases. Our urgent care center offers an array of Travel Vaccinations and Medications to ensure that you and your family are ready for your trip. We set up a customized immunization program based on the information you provide.


To save some time please fill out the travel vaccination questionnaire below and then book an appointment online.



Name
 
Sex
 
Date of Birth (MM/DD/YYYY)
 
Phone
 
Email
 
Your Destination
 
Dates of Tip
 
Purpose of your trip
 
Are you currently treated for any medical problems
 
Have you has a significant medical problem in the past
 
Could you be pregnant?
 
Are you staying mostly in cities/tourist destinations
 
Are you going to spend time in a rural area
 
Are you going to spend time above 5000 ft
 
Are you going to work in the foreign country
 
Are you allergic to eggs or chicken products
 
Have you has any hypersensitivity or reaction to vaccinations
 
Have you had Guillain-Barre Syndrome
Have you had all of your childhood vaccinations
 
 
Have you had tetanus/diphtheria vaccination in the last 10 years
 
Have you had measles vaccination (2 shots)
 
Have you had polio vaccination as an adult
 
Have you had hepatitis A vaccination (2 shots)
 
Have you had hepatitis B vaccination (3 shots)
 
Have you had meningitis vaccination in the past 3 years
 
Have you had typhoid vaccination in the past 2 yeats (if injected), or in the past 5 years (if oral)
 
Have you had yellow fever vaccination in the past 10 years
 
Have you had Japanese encephalitis vaccination in the past 2 years
 
List current or previous significant medical conditions
 
 
List current medications
 
 
Comments/Questions