Is your pharmacy looking to support the specific health needs of patients planning to travel? This Appointment type aims to optimize your travel consultation services and expand your pharmacy's reach and impact.
🌴 Interested in Travel Consultations? Please sign up using this request form
Patient Experience
Gathering detailed patient information for travel consultations ensures personalized, safety-focused care, empowering patients with tailored advice and fostering trust through a comprehensive, efficient experience.
For a full list of questions collected on the patient intake, see here.
MedMe collects the following information on the patient intake form:
Contact Information
Name
Address
Date of Birth
Gender
Email
Phone
General Health Information
Allergies, intolerances, and the reaction
Pregnant or Breastfeeding
Height
Weight
Medication List
Health Conditions
Cardiovascular diseases
Angina
Valve disease
History of blood clots
Heart attack
Arrhythmia
Other: _______________
Emotional/psychiatric conditions
Anxiety
Depression
Other: _______________
Lung diseases
Smoker
Asthma / COPD
Sleep Apnea
Require O2 Tank
Other: _______________
Neurological disorders
Multiple Sclerosis
Seizures
Migraines
Other: _______________
Immune disorders
No Spleen
Thymus Disorder
Organ Transplant
Other: _______________
Other
Kidney disease
Liver disease
Digestive issues
Acid Reflux / Heartburn
Cancer: ______________
Other: _______________
Childhood Vaccines (Yes/No/Unsure)
Travel Vaccines (Yes/No/Unsure)
Non-Travel Vaccines (Adult) (Yes/No/Unsure)
Travel Information
Trip Departure Date: _____________
Return Date: ______________
Number of Destinations
Destination Names
Reason for Trip:
Business
Tourism
Volunteer
Visiting Family / Friends
School / Study
Other: _______________
Visiting Rural Areas (Yes/No)
Travel accommodations:
All-inclusive resort
Hostel/local hotel
International hotel
Camping
Staying with friends or relatives
Other: _______________
Other trip features:
Scuba diving
Cruise ship
Contact with animals
High altitude (over 2000m)
Other: _______________
Do you plan on taking any tours? (Yes/No)
Are you an adventurous eater? (Yes/No)
Have you had issues with traveler’s diarrhea on previous trips? (Yes/No)
Do you have travel insurance? (Yes/No/Unsure)
Do you have medical evacuation insurance? (Yes/No/Unsure)
Please list any other questions or concerns you would like addressed during the appointment: _______________.
Pharmacy Experience
The pharmacist or pharmacy team member can edit consultation details during the appointment.
Request access to the Travel Consultation appointment type
Pharmacists can request access to the Travel Consultation appointment here. Our request process includes:
Submit the request on this form.
Confirmation and Queue: Upon confirmation, your request will be officially queued. Our team will report an approximate timeline within 1-3 business days, considering the current workload and an existing queue of requests.
Quality Assurance Testing: Before finalizing the appointment, we conduct thorough Quality Assurance testing to ensure its functionality and reliability.
Appointment Ready: Once available, our Customer Success team will notify you for review.
Is there another intake question you would like to see on this Travel Consultation Appointment? Share your idea here!
Have questions or looking to add new modules to your MedMe platform? Email us at care@medmehealth.com, or message us via live chat!
Have an idea or feature request? Please share on our feature requests board.