Appointments

To book an appointment, please complete the form below. NOTE: Our cancellation policy is 24 hour notice with a NO Show Fee of $50. Vaccines are an extra charge after consult fees and must be obtained on site during your service. TB Testing is $50 per step, a 2 step is required for first time testing.

Reason for Appointment*
When You Visit Us
Please bring a full list of prescription medications with you.
Have you been to JEMA before?
- Yes
- No
If No, please bring a list of immunuzations and dates received.
Please also provide a record of all childhood immunizations.
If you were born in Newfoundland, please contact Public Health Records at 752-4894.

How did you hear about our clinic?

If you are visiting us because you are travelling, please complete:

Date of Departure if travelling

Length of Stay if traveling

Countries to Visit if traveling

Reason for Appointment Request*

Number of Individuals Needing Appointment*

If work related, please provide company contact information:

Client #1

Name*

First Last

Date of Birth*

Family Doctor's Name

Phone Number (h)

Phone Number (w)

Phone Number (c)*

Mailing Address*

Email*

Client #2

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Client #3

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Client #4

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Client #5

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Client #6

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Comments

This field is for validation purposes and should be left unchanged.

The Travel Health and Vaccine Specialists

Appointments