{"id":341,"date":"2013-11-26T20:05:48","date_gmt":"2013-11-27T01:05:48","guid":{"rendered":"http:\/\/www.prescriptionshop.ca\/rxshop\/?page_id=341"},"modified":"2025-02-02T09:44:03","modified_gmt":"2025-02-02T14:44:03","slug":"travel-questionnaire","status":"publish","type":"page","link":"http:\/\/www.prescriptionshop.ca\/rxshop\/travel-clinic-2\/travel-questionnaire\/","title":{"rendered":"Travel Questionnaire"},"content":{"rendered":"\n<p class=\"has-vivid-red-color has-text-color has-medium-font-size\">Please note, this travel clinic is <strong><u><em>ONLY<\/em><\/u>&nbsp;<\/strong>for Carleton University students, faculty and staff. Non-students or staff will not be accepted.&nbsp;If you are unsure of your eligibility, please contact Carleton Health Services to confirm eligibility (generally within 6 months of graduating is deemed acceptable). Likewise, as stated in the FEES, the cost of a consultation is <strong>$65<\/strong>.<\/p>\n\n\n\n<p>Please ensure you bring your insurance information with you (the card itself, or a picture of the card front and back) to the appointment if you are a new patient so that we can bill any vaccines or medications through your insurance plan(s). Likewise, remember to book the <strong>VACCINE ADMINISTRATION appointment<\/strong> with the nurses at <strong>Health Services<\/strong> for any administration of prescribed vaccines. <\/p>\n\n\n\n<p><strong>Yellow Fever vaccine<\/strong> requires it to be done at<strong> least 10 days before entry<\/strong> into the country of question and requires you to bring your <strong>passport<\/strong> to Health Services to show alongside the vaccine. <strong>Meningococcal vaccine<\/strong> for Hajj or Umrah must show that the vaccine was administered <strong>at least 10 days before arrival in Saudi Arabia<\/strong> and is valid for 3 years for the polysaccharide vaccine, or within the last 5 years for the conjugate vaccine (we don&#8217;t carry the polysaccharide vaccine).<\/p>\n\n\n\n<p>For <strong>vaccination histories<\/strong>, if you went to school in Canada &#8211; you should be able to contact the public health authority where you went to school. A record of vaccinations is required to attend school.<\/p>\n\n\n<h3 style=\"text-align: center;\">Once you have submitted the questionnaire please call the pharmacy at<strong><em> 613-526-3666<\/em> <\/strong>to set up an appointment. &nbsp;Appointments will only be made once the questionnaire has been completed.<\/h3>\n<\/p>\n<noscript class=\"ninja-forms-noscript-message\">\n\tNotice: JavaScript is required for this content.<\/noscript>\n<div id=\"nf-form-3-cont\" class=\"nf-form-cont\" aria-live=\"polite\" aria-labelledby=\"nf-form-title-3\" aria-describedby=\"nf-form-errors-3\" role=\"form\">\n\n    <div class=\"nf-loading-spinner\"><\/div>\n\n<\/div>\n        <!-- That data is being printed as a workaround to page builders reordering the order of the scripts loaded-->\n        <script>var formDisplay=1;var nfForms=nfForms||[];var form=[];form.id='3';form.settings={\"objectType\":\"Form Setting\",\"editActive\":false,\"title\":\"Travel Questionnaire \",\"show_title\":1,\"clear_complete\":1,\"hide_complete\":1,\"default_label_pos\":\"above\",\"wrapper_class\":\"\",\"element_class\":\"\",\"key\":\"\",\"add_submit\":0,\"currency\":\"\",\"unique_field_error\":\"A form with this value has already been submitted.\",\"logged_in\":false,\"not_logged_in_msg\":\"\",\"sub_limit_msg\":\"The form has reached its submission limit.\",\"calculations\":[],\"formContentData\":[\"first_and_last_name_1539870956957\",\"date_of_birth_day_month_year_1553275504465\",\"address_1537370964390\",\"phone_1537370967235\",\"student_number_or_employee_number_1580740832055\",\"please_list_any_allergies_you_might_have_1537371152403\",\"please_briefly_describe_the_activities_that_you_will_be_undertaking_during_your_trip_1537371202308\",\"please_enter_your_departure_date_list_the_countries_you_will_be_visiting_the_duration_of_the_visit_and_where_you_will_be_staying_ie_hotel_hostel_etc_1539275915148\",\"please_list_any_other_medical_conditions_you_may_have_1537372690336\",\"please_list_any_other_medications_you_may_take_prescription_and_herbal_1537372726929\",\"have_you_received_any_of_the_following_vaccinations_1540910717348\",\"have_you_had_any_travel_vaccinations_if_yes_please_list_them_1539871022419\",\"if_available_please_list_the_dates_you_received_these_vaccinations_1540910819538\",\"do_you_drink_alcohol_if_yes_how_many_drinks_per_week_1539868834820\",\"do_you_smoke_if_yes_how_many_packs_per_week_1539868868980\",\"females_is_there_a_chance_you_may_be_pregnant_1539868958098\",\"submit_1585747631013\"],\"allow_public_link\":0,\"embed_form\":\"\",\"ninjaForms\":\"Ninja Forms\",\"changeEmailErrorMsg\":\"Please enter a valid email address!\",\"changeDateErrorMsg\":\"Please enter a valid date!\",\"confirmFieldErrorMsg\":\"These fields must match!\",\"fieldNumberNumMinError\":\"Number Min Error\",\"fieldNumberNumMaxError\":\"Number Max Error\",\"fieldNumberIncrementBy\":\"Please increment by \",\"fieldTextareaRTEInsertLink\":\"Insert Link\",\"fieldTextareaRTEInsertMedia\":\"Insert Media\",\"fieldTextareaRTESelectAFile\":\"Select a file\",\"formErrorsCorrectErrors\":\"Please correct errors before submitting this form.\",\"formHoneypot\":\"If you are a human seeing this field, please leave it empty.\",\"validateRequiredField\":\"This is a required field.\",\"honeypotHoneypotError\":\"Honeypot Error\",\"fileUploadOldCodeFileUploadInProgress\":\"File Upload in Progress.\",\"fileUploadOldCodeFileUpload\":\"FILE UPLOAD\",\"currencySymbol\":\"&#36;\",\"fieldsMarkedRequired\":\"Fields marked with an <span class=\\\"ninja-forms-req-symbol\\\">*<\\\/span> are required\",\"thousands_sep\":\",\",\"decimal_point\":\".\",\"siteLocale\":\"en_US\",\"dateFormat\":\"d\\\/m\\\/y\",\"startOfWeek\":\"1\",\"of\":\"of\",\"previousMonth\":\"Previous Month\",\"nextMonth\":\"Next Month\",\"months\":[\"January\",\"February\",\"March\",\"April\",\"May\",\"June\",\"July\",\"August\",\"September\",\"October\",\"November\",\"December\"],\"monthsShort\":[\"Jan\",\"Feb\",\"Mar\",\"Apr\",\"May\",\"Jun\",\"Jul\",\"Aug\",\"Sep\",\"Oct\",\"Nov\",\"Dec\"],\"weekdays\":[\"Sunday\",\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\",\"Saturday\"],\"weekdaysShort\":[\"Sun\",\"Mon\",\"Tue\",\"Wed\",\"Thu\",\"Fri\",\"Sat\"],\"weekdaysMin\":[\"Su\",\"Mo\",\"Tu\",\"We\",\"Th\",\"Fr\",\"Sa\"],\"recaptchaConsentMissing\":\"reCaptcha validation couldn&#039;t load.\",\"recaptchaMissingCookie\":\"reCaptcha v3 validation couldn&#039;t load the cookie needed to submit the form.\",\"recaptchaConsentEvent\":\"Accept reCaptcha cookies before sending the form.\",\"currency_symbol\":\"\",\"beforeForm\":\"\",\"beforeFields\":\"\",\"afterFields\":\"\",\"afterForm\":\"\"};form.fields=[{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":1,\"type\":\"firstname\",\"label\":\"First &amp; Last Name\",\"key\":\"first_and_last_name_1539870956957\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"custom_name_attribute\":\"fname\",\"personally_identifiable\":1,\"drawerDisabled\":false,\"value\":\"\",\"id\":9,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"firstname\",\"element_templates\":[\"firstname\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":2,\"type\":\"textbox\",\"label\":\"Date of Birth (day\\\/month\\\/year)\",\"key\":\"date_of_birth_day_month_year_1553275504465\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":72,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":3,\"type\":\"address\",\"label\":\"Address\",\"key\":\"address_1537370964390\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"address\",\"personally_identifiable\":1,\"value\":\"\",\"id\":11,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"address\",\"element_templates\":[\"address\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":4,\"type\":\"phone\",\"label\":\"Phone\",\"key\":\"phone_1537370967235\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"drawerDisabled\":false,\"value\":\"\",\"id\":12,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":5,\"type\":\"textbox\",\"label\":\"Student Number or Employee Number\",\"key\":\"student_number_or_employee_number_1580740832055\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"drawerDisabled\":false,\"id\":76,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":7,\"type\":\"textarea\",\"label\":\"Please list any allergies you might have\",\"key\":\"please_list_any_allergies_you_might_have_1537371152403\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":15,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":8,\"type\":\"textarea\",\"label\":\"Please briefly describe the activities that you will be undertaking during your trip.\",\"key\":\"please_briefly_describe_the_activities_that_you_will_be_undertaking_during_your_trip_1537371202308\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":16,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":9,\"type\":\"textarea\",\"label\":\"Please enter your departure date, list the countries you will be visiting, the duration of the visit and where you will be staying. (ie, hotel, hostel, etc) \",\"key\":\"please_enter_your_departure_date_list_the_countries_you_will_be_visiting_the_duration_of_the_visit_and_where_you_will_be_staying_ie_hotel_hostel_etc_1539275915148\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":17,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":10,\"type\":\"textarea\",\"label\":\"Please list any other medical conditions you may have\",\"key\":\"please_list_any_other_medical_conditions_you_may_have_1537372690336\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":19,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":11,\"type\":\"textarea\",\"label\":\"Please list any other medications you may take, prescription and herbal\",\"key\":\"please_list_any_other_medications_you_may_take_prescription_and_herbal_1537372726929\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":21,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":12,\"type\":\"listcheckbox\",\"label\":\"Have you received any of the following vaccinations?\",\"key\":\"have_you_received_any_of_the_following_vaccinations_1540910717348\",\"label_pos\":\"above\",\"required\":false,\"options\":[{\"errors\":[],\"max_options\":0,\"label\":\"diphtheria & tetanus\",\"value\":\"diphtheria-and-tetanus\",\"calc\":\"\",\"selected\":0,\"order\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"label\":\"hepatitis B\",\"value\":\"hepatitis-b\",\"calc\":\"\",\"selected\":0,\"order\":1,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"label\":\"hepititis A\",\"value\":\"hepititis-a\",\"calc\":\"\",\"selected\":0,\"order\":2,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":3,\"new\":false,\"options\":[],\"label\":\"typhoid (oral or injection)\",\"value\":\"typhoid-oral-or-injection\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":4,\"new\":false,\"options\":[],\"label\":\"measles\\\/mumps\\\/rubella\",\"value\":\"measles-mumps-rubella\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}},{\"errors\":[],\"max_options\":0,\"order\":5,\"new\":false,\"options\":[],\"label\":\"polio\",\"value\":\"polio\",\"calc\":\"\",\"selected\":0,\"settingModel\":{\"settings\":false,\"hide_merge_tags\":false,\"error\":false,\"name\":\"options\",\"type\":\"option-repeater\",\"label\":\"Options <a href=\\\"#\\\" class=\\\"nf-add-new\\\">Add New<\\\/a> <a href=\\\"#\\\" class=\\\"extra nf-open-import-tooltip\\\"><i class=\\\"fa fa-sign-in\\\" aria-hidden=\\\"true\\\"><\\\/i> Import<\\\/a>\",\"width\":\"full\",\"group\":\"\",\"value\":[{\"label\":\"One\",\"value\":\"one\",\"calc\":\"\",\"selected\":0,\"order\":0},{\"label\":\"Two\",\"value\":\"two\",\"calc\":\"\",\"selected\":0,\"order\":1},{\"label\":\"Three\",\"value\":\"three\",\"calc\":\"\",\"selected\":0,\"order\":2}],\"columns\":{\"label\":{\"header\":\"Label\",\"default\":\"\"},\"value\":{\"header\":\"Value\",\"default\":\"\"},\"calc\":{\"header\":\"Calc Value\",\"default\":\"\"},\"selected\":{\"header\":\"<span class=\\\"dashicons dashicons-yes\\\"><\\\/span>\",\"default\":0}}}}],\"container_class\":\"\",\"element_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"drawerDisabled\":false,\"id\":55,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"parentType\":\"list\",\"element_templates\":[\"listcheckbox\",\"input\"],\"old_classname\":\"list-checkbox\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":13,\"type\":\"textarea\",\"label\":\"Have you had any travel vaccinations? If yes, please list them.\",\"key\":\"have_you_had_any_travel_vaccinations_if_yes_please_list_them_1539871022419\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":52,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":14,\"type\":\"textarea\",\"label\":\"If available, please list the dates you received these vaccinations \",\"key\":\"if_available_please_list_the_dates_you_received_these_vaccinations_1540910819538\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":56,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textarea\",\"element_templates\":[\"textarea\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":15,\"type\":\"textbox\",\"label\":\"Do you drink alcohol? If yes, how many drinks per week?\",\"key\":\"do_you_drink_alcohol_if_yes_how_many_drinks_per_week_1539868834820\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":51,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":16,\"type\":\"textbox\",\"label\":\"Do you smoke? If yes, how many packs per week?\",\"key\":\"do_you_smoke_if_yes_how_many_packs_per_week_1539868868980\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":53,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":17,\"type\":\"textbox\",\"label\":\"Females: is there a chance you may be pregnant?\",\"key\":\"females_is_there_a_chance_you_may_be_pregnant_1539868958098\",\"label_pos\":\"above\",\"required\":false,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"drawerDisabled\":false,\"value\":\"\",\"id\":54,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":18,\"type\":\"submit\",\"label\":\"Submit \",\"processing_label\":\"Call pharmacy now\",\"container_class\":\"\",\"element_class\":\"\",\"key\":\"submit_1585747631013\",\"drawerDisabled\":false,\"id\":30,\"beforeField\":\"\",\"afterField\":\"\",\"value\":\"\",\"label_pos\":\"above\",\"parentType\":\"textbox\",\"element_templates\":[\"submit\",\"button\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap-no-label\"}];nfForms.push(form);<\/script>\n        ","protected":false},"excerpt":{"rendered":"<p>Please note, this travel clinic is ONLY&nbsp;for Carleton University students, faculty and staff. Non-students or staff will not be accepted.&nbsp;If you are unsure of your eligibility, please contact Carleton Health Services to confirm eligibility (generally within 6 months of graduating is deemed acceptable). Likewise, as stated in the FEES, the cost of a consultation is [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":29,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-341","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/pages\/341","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/comments?post=341"}],"version-history":[{"count":32,"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/pages\/341\/revisions"}],"predecessor-version":[{"id":3962,"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/pages\/341\/revisions\/3962"}],"up":[{"embeddable":true,"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/pages\/29"}],"wp:attachment":[{"href":"http:\/\/www.prescriptionshop.ca\/rxshop\/wp-json\/wp\/v2\/media?parent=341"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}