Family Travel Appointment Request

101 Pharmacy & Travel Clinic

Call Us: 403.455.8648

Phone: *

Traveler no.3's Birth Date:

Traveler no.5 Alberta Health Card: *

Are you traveling with your child(ren) under 5 years old? *

Yes

Contact Person's Name: *

Traveler no.1's Name: *

Departure and Return Date: *

Traveler no.4's Birth Date:

Traveler no.3 Alberta Health Card: *

Email: *

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Traveler no.3's Name:

Traveler no.1's Birth Date: *

Traveler no.1 Alberta Health Card: *

Traveler no.4's Name:

How many people are coming to the appointment? *

Traveler no.2's Name: *

Traveler no.5's Birth Date:

IMPORTANT: If you are traveling with children under 5 years old, our registered nurse is needed to provide the vaccinations.

Our registered nurse is only available on selected Saturdays. Please call us for availability.

You may also come for your travel consultation first and receive your injections on a separate day, please call us for details.

Traveler no.4 Alberta Health Card: *

Address

1107 Centre Street, NW

Calgary, AB, Canada

FAMILY TRAVEL APPOINTMENT REQUEST

Traveler no.2's Birth Date: *

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Office Hours

Monday - Friday: 9:00 am - 6:00 pm.

Saturday: 10:00 am - 6:00 pm.

Sunday & Holidays: Closed

Traveler no.2 Alberta Health Card: *

Travel Destination(s): *

Traveler no.5's Name:

Preferred Appointment Date and time *

Phone

403.455.8648