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Please bring a printed copy of your completed consent form and a printed copy of your driver's license and insurance card to the clinic. Thank you!
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Flu Shot Quadrivalent
Countries of Travel
Unknown/Not Applicable
Afghanistan
Agrihan
Aitutaki
Alamagan
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Balearics
Bangladesh
Barbados
Barbuda
Bathurst-Island
Belarus
Belau
Belgium
Belize
Benin
Bermuda
Bhutan
Bikini-Atoll
Bismarck-Archipel
Bolivia
Bonaire
Bosnia-Herzegovina
Botswana
Bougainville
Brazil
British Virgin Islands
British West Indies
Brunei
Bulgaria
Burkina Faso
Burundi
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Caicos Islands
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Ceylon
Chad
Chile
China
Christmas Islands
Cocos Islands
Colombia
Comino
Comoros
Congo, Republic of the
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of Congo
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Efate
Egypt
El Salvador
Eniwetok-Atoll
Equatorial Guinea
Eritrea
Espiritu Santo
Estonia
Ethiopia
Faeroe Island
Falkland Islands
Fiji Islands
Finland
Formentera
France
French Guiana
French Polynesia
Fuerteventura
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Gilbert-Islands
Gomera
Gozzo
Gran Canaria
Great Britain
Greece
Greenland
Grenada
Grenadines
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hawaii
Hierro
Honduras
Hong Kong SAR
Hungary
Ibiza
Iceland
India
Indonesia
Iran
Iraq
Ireland
Irian Jaya
Israel, the West Bank and Gaza
Italy
Jamaica
Japan
Java
Jordan
Kaliningrad
Kangaroo-Island
Kazakhstan
Kenya
King-Island
Kiribati
Korea (North)
Korea (South)
Kosovo
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Kuwait
Kyrgyzstan
La Palma
Lanzarote
Laos
Latvia
Lebanon
Leeward Islands
Lesotho
Liberia
Libya
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Line Islands
Lithuania
Louisiade-Archipel
Luxembourg
Macau
Macedonia
Madagascar
Magarita
Malakka
Malakula
Malawi
Malaysia
Maldives
Mali
Mallorca
Malta
Manihiki
Marianas
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Menorca
Mexico
Micronesia
Miquelon
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Mwali
Myanmar (Burma)
Namibia
Nassau
Nauru
Nepal
Netherlands
Netherlands Antilles
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Nippon
Niue
Njazidja
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Norway
Nzwani
Oman
Pagan
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Penrhyn
Persia
Peru
Philippines
Phonix-Islands
Pitcairn Islands
Poland
Ponape
Portugal
Principe
Puerto Rico
Qatar
Ralik-Islands
Rarotonga
Ratak-Islands
Reunion
Rodrigues
Romania
Rota
Russia
Rwanda
Sabah
Saint Barthelemy
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Vincent and the Grenadines
Saipan
Samoa
Samoa (USA)
San Marino
Sao Tome & Principe
Sarawak
Sardinia
Saudi Arabia
Savai`i
Scotland
Senegal
Serbia
Seychelles
Sicily
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St. Christopher
St. Eustatius
St. Helena
St. Martin
St. Pierre & Miquelon
Sudan
Sulawesi
Sumatra
Sunda-Islands
Suriname
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanna
Tanzania
Tasmania
Teneriffa
Thailand
Tibet
Tinian
Tobago
Togo
Tokelau-Islands
Tonga
Trinidad & Tobago
Truk-Islands
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Upolu
Uruguay
USA
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wake Island
Wales
Walfischbay
West-Karolines
Yap-Islands
Yemen
Zambia
Zimbabwe
Need help? Contact us at
michele@passporthealthlouisiana.com
.
Passport Health is committed to keeping your personal data safe and we take every reasonable precaution to ensure security. Access to your personal information is restricted to employees at Passport Health. Your personal data is used for internal purposes only and is never sold or shared with anyone outside of Passport Health.
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