Lakemont Pharmacy

Community. Connected. Care.

Pre-Travel Questionnaire (Form)

Pre-Travel Questionnaire can be downloaded from this link: Pre-Travel Questionnaire

Please note:

  • The purpose of this form is to obtain travel itinerary, medical and vaccination records and other information needed for the pre-travel health consultation.
  • Please complete the form (one form for each traveler) and bring the completed form with you to your appointment.
  • If you have not requested an appointment, please do so here: appointment.

 

 

Lakemont Pharmacy | 4935 Lakemont Blvd SE, Suite B4, Bellevue, WA 98006 | (425)-644-6080 | HIPAA Notice of Privacy Practices Frontier Theme