The Vaccine People  

Tel:  (415) 461-2866 
Toll Free: 888-499-7277 
Fax: (415) 461-2832

info@ passportsf.com

Medical Director:
Kenneth J. Gjeltema, M.D.

Operations Manager: Judi Anderson, R.N.

1331 South Eliseo Drive, Suite 1802
Greenbrae, CA 94904

500 San Pablo Avenue, Suite #300
Albany, CA 94706

944 Market St. 
Suite 704
San Francisco , CA 94102

970 Dewing Ave.
Suite 202
 Lafayette , CA 94549

85 Saratoga Ave.
Suite 211
Santa Clara , CA 95051

 
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PATIENT FORMS
 
  

To save time we suggest you fill out our Patient Travel Health Information Form
prior to your appointment at Passport Health. You can then bring in the form with
you at the time of your appointment or even better, fax it to us ahead of time at
(415)461-2832.

Appointments are required at all of our convenient Bay area locations.

Please click on Passport Health Forms below to obtain a printable file of the two page form.  Depending upon your computer, these may be downloaded or printed directly from your web browser or word processor.

Patient Intake Form (PDF)
Get Adobe Reader
The forms below are available in Adobe PDF format. If you do not have Adobe Reader then click here to download it.

If you have any questions about this form or any matter relating to travel health, please do not hesitate to contact us by using the email link below or by calling our offices at (415) 461-2866.

E-mail:  info@ passportsf.com

THANK YOU!