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Forms

Here are some forms you may download and complete at your convenience.

 

Regular Forms

When Needed 

#1. Clinic Visit Registration Form

Every visit to AITC

#2  Medicare Status Declaration Form

Every visit to AITC

#3. Complete Medical History & Travel Itinerary Form

This is your first visit to AITC

-or-

It's been at least 1 year since your last visit to AITC

-or-

You are planning international travel 

#4. Interval Medical History Form

You have visited AITC within the past year, and you are not planning international travel

#5. Preauthorized Healthcare Payment Form

Blue Shield of California PPO Members planning international travel

 

 

Forms for Special Situations 
#6. Tuberculosis Testing

PDF

#7. Shingles Vaccine

PDF

#8. Authorization to Disclose Health Information

PDF

 

 

 

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