Appointment Request
Please note that travel medicine is not a provincially or federally funded service (i.e. Medicare). As like every other travel health clinic in Canada, fees apply for consultations as well as vaccinations. These fees may or may not be covered by your private insurance provider.

Please fill out and submit this form and we will get back to you with appointment confirmation.

Note: All fields are required.
First Name:  
Last Name:  
Email Address:  
Phone Number:  
Clinic Requested:  
Type of Consultation:  
Travel Destination(s):
 
Total Travel Duration:  
Requested Appointment Date 1:
<January 2012>
SunMonTueWedThuFriSat
25262728293031
1234567
891011121314
15161718192021
22232425262728
2930311234
 
Requested Time:  
Requested Appointment Date 2:
<January 2012>
SunMonTueWedThuFriSat
25262728293031
1234567
891011121314
15161718192021
22232425262728
2930311234
 
Requested Time:  
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