Forms & Price Lists
FORMS
For your convenience several of our clinic forms are available online. To save time and expedite your appointment, feel free to fill out any of the forms below and bring them with you to your first or subsequent visits.
You will need Adobe Acrobat Reader to print these files, click the link below to download Adobe Acrobat.
Forms for you initial clinic visit, or if you haven't been seen for more than one year.
Travel Clinic New Patient Forms
Other Useful Forms:
Authorization to Disclose Medical Records
PRICE LISTS
All travel medicine services start with a comprehensive travel medicine consultation. The cost of this office visit is $59.00.
Because of manufacturer price fluctuations and other factors vaccine pricing is variable. The prices below contains some of the most requested vaccines and their current prices. Please note that prices are subject to change at any time.
For your convenience several of our clinic forms are available online. To save time and expedite your appointment, feel free to fill out any of the forms below and bring them with you to your first or subsequent visits.
You will need Adobe Acrobat Reader to print these files, click the link below to download Adobe Acrobat.
Forms for you initial clinic visit, or if you haven't been seen for more than one year.
Travel Clinic New Patient FormsOther Useful Forms:
Authorization to Disclose Medical RecordsPRICE LISTS
All travel medicine services start with a comprehensive travel medicine consultation. The cost of this office visit is $59.00.
Because of manufacturer price fluctuations and other factors vaccine pricing is variable. The prices below contains some of the most requested vaccines and their current prices. Please note that prices are subject to change at any time.
| Office Visit | $59.00 |
| Follow up visit for established patients (same trip, or to complete shot series) |
$29.00 |
| Vaccine Administration, first vaccine | $19.00 |
| Vaccine Administration, each additional | $9.00 |
| Hepatitis A - Adult | $79.99 |
| Hepatitis A - Pediatric | $59.99 |
| Hepatitis B - Adult | $89.99 |
| Hepatitis B - Pediatric | $49.99 |
| Influenza | $34.99 |
| Japanese Encephalitis Virus | CALL |
| Meningococcal Meningitis | $134.99 |
| MMR | CALL |
| Pneumococcal | $59.99 |
| Polio | $54.99 |
| Rabies | CALL |
| Tetanus | $39.99 |
| Typhoid Injection | $69.99 |
| Typhoid Oral | CALL |
| Varicella | CALL |
| Yellow Fever | $109.99 |
Make an appointment
We offer immunizations and in-depth travel consultations tailored to your specific destination and individual health needs.
» Make an appointment
Our Clinic Travel Store
For your convenience, we carry a wide range of travel products onsite—so you can pick up last-minute and hard-to-find items that are a must for any trip abroad.
» Visit our clinic
Travel Health
50% of American travelers (13 million) are at risk for vaccine-preventable Hepatitis A and Hepatitis B.
