Traveler's Health and Destination Questionnaire

Please print, complete and bring this form with you

Immunization and Prescription Consent Form

Please print, complete and bring this form with you

Method of Payment

Payment in full is expected upon receiving the traveler's health services. Check, cash and credit accepted.

***PLEASE BRING YOUR IMMUNIZATION RECORD (or YELLOW TRAVEL CARD) TO YOUR VISIT.

Traveler's Health Registration

and Vaccine Consent Form

Please fill out the following medical history and  travel itinerary form in order to expedite your travel clinic visit. We look forward to serving you and preparing you for your stay abroad.
Are you experiencing any flu symptoms?
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Traveler's Health Clinic of North Alabama

1890 Alabama Highway 157, Suite 420 Cullman, AL 35058

Tel: 256-739-7050

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