International Travel

International Travel Forms

You may print the following forms and bring them to the appointment with you.

New Client Forms:

Notice of Privacy Practice

Privacy Practice Signature Page

Client Information Form

Travel Health Assessment

Insurance Form

Consent Form

Subsequent Visit Forms:

Follow Up Travel Appointment

Insurance Form (fill out only if your insurance has changed since your last visit)


General Information:

Self Treatable Conditions and Potential Risks Information

Contact Us



(989) 832-6661

International Travel:

(989) 832-6667

Please call to schedule an appointment.

Business Hours:

Monday 8am-5pm
Tuesday 8am-5pm
Wednesday 8am-5pm
Thursday 8am-5pm
Friday 8am-5pm

Immunization Hours:

Tuesday 8:30am-5pm
Thursday    8:30am-5pm
Friday 8:30am-5pm

International Travel Hours:

Monday 8:15am- 4:45pm
Tuesday 8:15am- 4:45pm
Wednesday 1:00pm- 4:15pm
Thursday 8:15am- 11:15am
Friday Closed


(989) 486-9064


220 W. Ellsworth St.

Midland, MI 48640

Find Us

Directions to Midland County Health Dept


Google Maps