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.

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

Length of Stay

Countries to Visit

Reason for Appointment Request*

Number of Individuals Needing Appointment*

If work related, please provide company contact information:

Traveler #1

Name

First Last

Date of Birth

Family Doctor's Name

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Email*

Traveler #2

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Traveler #3

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Traveler #4

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Traveler #5

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Traveler #6

Name

First Last

Date of Birth

Phone Number (h)

Phone Number (w)

Phone Number (c)

Mailing Address

Name

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

The Travel Health and Vaccine Specialists

Appointments