Travel Questionnaire and Health History
We provide several options for completing the Travel Questionnaire and Health History. Non-Travelers just need to complete the Medical History section. We must have this questionnaire completed and submitted to us inadvance of your office visit.
The Travel Questionnaires (and Vaccine and Medication requests) may be:
1) completed online by clicking the link below:
2) To download the Travel Questionnaire, then faxed (410-788-6859) or email to our office L.Nwokeafor@lcnservicesllc.com. Just click the link below to download. Adobe Reader is required and may also be needed for download.
Download PDF here for Travel Questionnaire
3) Emailed or faxed to you! Please contact our office at 240-554-5923, or request for an email of the form sent to L.Nwokeafor@lcnservicesllc.com.