Online Appointment Request

Welcome!

Appointment Request Online

To schedule a visit, please complete and submit the form provided.

If you need further assistance, feel free to call us at 626-584-1200.

Clinic Address:
1250 East Green Street
Pasadena, CA 91106

🌐 www.healthytraveler.com
Clinic Hours & Important Visit Information

Our clinic is open by appointment only on the following days:
Monday – Friday
Closed on all U.S. federal holidays.

Please note the following guidelines for your visit:

Face masks are recommended
Patients only are permitted to enter. No guests or companions allowed.
If you have any questions or concerns, feel free to contact us:

📞 Call: 626-584-1200
📱 Text only: 626-344-7544

All messages are monitored 24/7, and we respond in a timely manner.
Important Insurance Information Regarding Travel Vaccines

Please be aware that your insurance may not cover the cost of travel vaccines in the following cases:

• Your medical insurance is provided by an employer
• You are covered by Medicare (including Part D) or have a secondary payer
• You are enrolled in Medi-Cal or Medicaid

We are not part of any insurance network and therefore cannot bill insurance providers directly. At the conclusion of your visit, we will provide you with a statement that includes the appropriate billing codes for your records or for possible reimbursement submission.

Thank you for your understanding.
I would like to schedule an appointment for:*

Comprehensive Travel Medicine Review of Travel Plans & VaccinesYellow Fever Vaccine Administration and ReviewDispense Oral Malaria Medication at ClinicMeningitis Vaccine Administration OnlyTyphoid Vaccine Administration OnlyTdap Only (Tetanus, Diphtheria & Whooping Cough) Administration OnlyReturn for Booster Shot(s)Seasonal Flu Shot Only - Regular DoseSeasonal Flu Shot Only - High Dose for 65+ years youngOther
Are you?*

New PatientReturning Patient- last visit less than 12 months ago.Returning Patient- last visit more than 12 months ago.Minor under 18Age 64+
Full Name*

First NameLast Name
E-mail*
Your Cellular Mobile Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Type of Alternate phone number above?

Mobile CellphoneHomeOffice
Enter FIRST date you would like to schedule:*

MonthDayYear
Date
Your FIRST appointment date above, choose one of the following:*

Morning Appointments, Monday to Thursday, 0900 AM to 11130 AMAfternoon Appointments, Monday to Thursday, 0100 PM to 0430 PMFriday Morning Appointment, 0900 AM to 1230 PM.
Enter SECOND alternate date you would like to schedule:

MonthDayYear
Date
Your SECOND appointment date above, choose one of the following:?*

Morning Appointments, Monday to Thursday, 0900 AM to 1130 AMAfternoon Appointments, Monday to Thursday, 0100 PM to 0430 PMFriday Morning Appointment, 0900 AM to 1230 PM.
Number of Patients Requesting Appointments*
Additional Name for Appointment

First NameLast Name
Additional Name for Appointment

First NameLast Name
Additional Name for Appointment

First NameLast Name
Type of Travel*

VacationBusinessCruiseAdventure TravelStudy AbroadForeign RelocationMissionaryOtherOther
Departure Date of Travel*

MonthDayYear
Date
Countries of Travel*
Please list by Country Name or City or Region
Additional Message to Clinic:
List of vaccines needed., medical concerns..etc.
Referral to Healthy Traveler Clinic by:

Returning PatientReferral from PhysicianReferral from Friends/FamilyCenters for Disease Control WebsiteGoogle Search EngineYahoo Search EngineBing Search EngineFacebookTwitterPasadena Public Health DepartmentOther
Copyright MMXXIV. Healthy Traveler® is a registered trademark with the United States Patent and Trademark Office and Canadian Office of Intellectual Properties. No whole or partial reproduction of this website including printed or electronic is allowed without written permission from Healthy Traveler. All Rights Reserved.
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