Travel Vaccination Questionnaire // Circle Health

Acknowledgement of Fees

By checking this box I acknowledge that travel vaccines and consultations are generally not covered by insurance.

The average cost for a travel consultation with vaccines is approximately $320, which typically includes the consultation fee and two of the most common vaccines that are recommended.

Acknowledgement of Vaccination Records

By checking this box I acknowledge that I will bring a complete written record of all my previous vaccinations.

Without these records we will have to rely on your questionnaire answers when making recommendations.

Urgent Care

Travel Vaccination Questionnaire

Circle Health Urgent Care

Acknowledgement of Fees

Patient information

Contact information

Travel information

Please Answer the Following Questions

Acknowledgement of Vaccination Records