Imperial County Health Department in El Centro, CA 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Last Name and First Name in the designated fields. Ensure accuracy for identification purposes.
3. Fill in your Sex, Weight, Home Phone, Date of Birth, Age, Place of Birth, Work Phone, Cell Phone, Email, and Address. This information is crucial for health assessments.
4. In the Itinerary section, list all countries or destinations you plan to visit along with the corresponding dates for each location.
5. Indicate your Date of Departure and Date of Return. This helps track your travel history.
6. Check all applicable boxes under Trip Details and Travel by sections to provide a comprehensive overview of your travel plans.
7. Complete the Immunization History section by answering questions regarding past vaccinations and any allergies you may have.
8. Finally, review all entries for accuracy before signing at the bottom as both the traveler and health care provider if applicable.

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