Download Travel Clinic Patient Forms

If you would like to use Village Drug Shop Travel Clinic, please download and complete the two forms below.  We use this information to make an assessment about which travel medications and vaccines are right for you AND are specific to your destination and activities.  
  • If you have immunizations records, please send those as well.  

  • Please attach a photo/copy of your prescription insurance information with your completed travel forms.
  • We can attempt to bill your prescription insurance for your immunizations and travel prescriptions.  There is no guarantee that your insurance will cover these types of medications or immunizations.  You should contact your insurance company for more information.

Once complete, send them back to us either by email (villagedrugtravel@gmail.com) or by fax (706-548-2193). 
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Village Drug Shop Travel Clinic,
Aug 31, 2017, 1:57 PM
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Village Drug Shop Travel Clinic,
Aug 31, 2017, 1:57 PM