Below are links to our travel medicine demographics form, our travel medicine patient history form and our secure ID image upload portal.  Please fill out both forms completely and make sure you received confirmation of submission.  Please upload a copy of a government issued ID (required for all clients).

Regarding the security of these forms:  Click here to find our more about how we secure the information you submit online.  If you have any concerns about submitting your information online, please contact our office.

Please make sure you fill out both forms and complete all steps below.  

If the client is less than 18 years old, these forms must be filled out by a parent or guardian.

Step 1

Travel Medicine Consult Demographics Form

Step 2

Travel Medicine Consult History Form

Step 3

Upload Image of Government Issued ID