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Complete This Form For a Travel Consultation

Travel Consultation Form

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Departure Date
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Return Date
Destination(s): Please tell us which countries and cities are you visiting.
Are you traveling with your child(ren) under 5 years old?(Required)
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Preferred Appointment Time(Required)
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We open: M-F 9-6, Sat 10-6, Closed on Sun.
Traveler no 1's Name
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Traveler no 1's Birth Date
Traveler no 2's Name
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Traveler no 2's Birth Date
Traveler no 3's Name
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Traveler no 3's Birth Date
Traveler no 4's Name
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Traveler no 4's Birth Date
Traveler no 5's Name
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Traveler no 5's Birth Date
Travel Assessment Fee is mandatory, $50 for first person and $30 for each additional person. Injection Fee is $20 per vaccine.(Required)
This field is for validation purposes and should be left unchanged.

TB Skin Test

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Date Of Birth
Vaccines received in the past 6 weeks or other health concern(s)
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Preferred Appointment Time(Required)
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We open: M-F 9-6, Sat 10-6, Closed on Sun.
I understand that I must return between 48-72 hours for skin test measurement. Fail to do so, my TB skin test is void. I will need to pay again if I choose to redo the test.(Required)

We charge $20.00 of injection fee per vaccine. Please note that the injection fees do not include the costs of the vaccines.

TB test is $55.00.

It is a two-appointment test! You are required to return 48 HOURS after the initial appointment for reassessment.
If you have received a LIVE VACCINE recently, you will have to wait at least 30 DAYS after the vaccination to receive the TB test.