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Travel Vaccine Planner

Travel Vaccine Planner 1. Emergency Contact 2. Travel History 3. Travel Itinerary 4. Childhood and Adult Immunizations 5. Health History

The travel vaccine planner is a health history information form specific to travel risks. You are to bring a completed travel vaccine planner to your appointment.

If you do not bring a completed travel planner to your travel visit you will be charged an extra $15. Without a completed travel vaccine planner there is more time involved for the travel health care provider with your appointment.

Travel Vaccine Planner - Microsoft Word

Travel Vaccine Planner - Acrobat pdf

Updated: 9/16/09