Pre-Travel Consultation Form - Prima Medical Group 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Information. Fill in the date, your full name, and Patient ID number. Ensure that your street address, city, state, ZIP code, primary phone number, other phone number, and email address are accurately provided.
3. In the Specific Travel Information section, list your travel destinations in order of visit. For each destination, specify the duration of stay and whether it is rural or urban.
4. Indicate the purpose of your travel by checking the appropriate box. You can select multiple options such as Adventure, Business, or Leisure.
5. Describe your style of travel and types of accommodation you plan to use by checking the relevant boxes.
6. List any planned activities during your trip in the designated area.
7. Complete the Personal Information section by answering whether you were born in the U.S., listing any health conditions, current medications, and allergies.
8. Finally, provide details about your previous vaccination history. Indicate any reactions to vaccinations if applicable.
9. Once completed, save your form and follow instructions for mailing or faxing it before your appointment.

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