Travel the world.


John D. Wilson, M.D.
1200 Hilyard St., Suite S-560
Eugene, Oregon 97401 USA
 541/343-6028   fax 485-7702
www.TravelClinicOregon.com

TO SCHEDULE AN APPOINTMENT

Please fill out and submit the following form. You will be contacted by phone to set up your appointment time.

Name:
Phone - Day:
Phone - Eve:
Phone - Cell:
E-mail address:
Date of departure:
Date of return:
Countries you will visit:
Number of travelers (with ages):
Times and Dates you would prefer for your appointment
Comments:
Back

The Travel Clinic Home

©  John D. Wilson, M.D. 1999-2005; Last Update 1/26/2005