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

Information we will need from you

Each traveler needs to complete a questionnaire and bring it along to the appointment.

If you do not already have this useful program, please DOWNLOAD FREE the latest version of Adobe® Acrobat® Reader® onto your hard disk.   This will allow you to print an exact copy of the questionnaire.
  1. Download the questionnaire to your screen by clicking either image below.
  2. When the form appears on the screen , choose Print from the File menu, then OK..
  3. Please print and fill in both pages of the questionnaire for each person in your group to bring to the office with you at the time of your visit.


Clicking on either page of the form downloads both pages.

 

Troubleshooting printing problems for PDF files can be found through the following links at Adobe's site:

 
Back

The Travel Clinic Home

Maps

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