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Please complete and submit this booking form to make an appointment for any of our travel health service offerings. Our staff member will contact you to confirm your appointment.
Full Name
*
First Name
Last Name
Number of Travelers
1
2
3
4
5+
Select total number of travelers attending the clinic for the Travel Health Assessment.
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Select the day and time you wish to book an appointment
*
-
Day
-
Month
Year
Date Picker Icon
1
2
3
4
5
6
7
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9
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:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Have you already submitted or will be submitting the Pre-Travel questionnaire online at our website prior to your arrival at the clinic?
Yes
No
Additional Message:
Submit
Should be Empty: