Download Travel Clinic Patient Forms

If you would like information about the Village Drug Shop Travel Clinic, please download and complete the "Travel Request Form" 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 after the free initial consultation you would like a full travel consultation, please complete the "VDS Travel Consent, HIPPA, Financial Policy form" below and return to us.

  • 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 ( or by fax (706-548-2193).

Download and print Travel Request Form.

Initial Travel Request Form.pdf

Download and print VDS Travel Consent, HIPPA, Financial Policy form.

FINAL VDS Travel Clinic Combined Form.pdf