Travel Consults and Yellow Fever Vaccine Appointments

Travel Consults and Yellow Fever Vaccine Appointments

Planning international travel? Tarrytown Pharmacy offers travel consults to go over which vaccines you may need before your trip and other helpful information. Additionally, some countries require or strongly recommend a Yellow Fever vaccine. This appointment fulfills the CDC requirement for a Yellow Fever vaccine consult. Tarrytown Pharmacy can provide both the vaccinations and the necessary travel consultation at the same time.
Please select an appointment type below. Adjust the quantity to indicate the number of individuals in your family or group needing a consult or yellow fever vaccine.*
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Travel Consultation (15 minutes)During a travel consult, a Tarrytown Pharmacy pharmacist will provide information concerning travel updates, required and recommended immunizations, and answer any other questions you might have. The vaccinations requested can also be given at this time. A travel consultation is REQUIRED to receive a yellow fever vaccine.
$49.99 Quantity

Total

$0.00
Important Details:
- The CDC requires a "Pre-Travel Consultation" for people receiving the Yellow Fever Vaccine
- The Yellow Fever Vaccine total cost is $330
  - If you have insurance, we process prescription insurance to see if they will help cover some or all of the cost
  - Uninsured or cash-pay patients are welcome
- The cost of this consult is not refundable if you cancel the appointment.
- Please note- medication for malaria prevention is often recommended for travel to many countries. We will go over the recommendation with you, but we do not have a provider on staff who can write a prescription for malaria prevention. If needed, your primary care provider or other physician would need to write a prescription for the medication.
- Please bring a copy of your vaccine records to the appointment, if available.
Appointment Scheduling

If you don't see a date or time that works for you, please call the pharmacy at 512-478-6419 to see if we can accomodate a different appointment time.
Yellow Fever Appointment*
Traveler Information and Demographics
Please indicate how many people are needing a vaccine/consultation:*

One PatientMore than one patient
Traveling Patient Name:*

First NameLast Name
Traveling Patient Date of Birth:*

MonthDayYear
Date

Primary Contact for Group*

First NameLast Name
Contact Phone Number*
Please enter a valid phone number.
Traveling Patient Email:*
example@example.com
Cell Phone Number:*
Please enter a valid phone number.
Traveling Patient Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload a photo of your prescription and medical insurance cards: (if applicable)

Cancelof
Patient Sex:*

MaleFemale
Where will you be traveling? (Please list all countries and cities)*
Please select your reason for traveling:*

BusinessLeisureVolunteeringOther
What areas will you be staying in?*

Rural (More remote areas)Urban (Bigger cities)Other
What date will you be leaving for your trip?*

MonthDayYear
Date
How long will you be traveling? *
Do you know of any required immunizations that you need before traveling?*

YesNo
What required immunizations were you told you needed?*

Health Questionnaire:*

	Yes	No	I Don't Know
Do you have any chronic medical conditions? (kidney or liver disease, diabetes, etc)
Do you have any drug allergies?
Do you have a severe allergy to eggs?
Do you have any immunocompromising conditions?
Do you expect to come in contact with animals on your travels?
Have you traveled internationally before?

Please tell us any other information you'd like us to know, or questions you would like us to help answer:
How did you hear about our travel services?

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

	Indicate Patient Needing Vaccine/Consult (Yes/No)	Patient Name:	Date of Birth: (mm/dd/yyy)	Patient Gender:	Patient Address:	Patient Cell Phone #:	Patient Email:
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6

Travel Consults and Yellow Fever Vaccine Appointments

Important Details:

Appointment Scheduling

Traveler Information and Demographics