Immigration Form Requirements
*All individuals presenting to New Day Pediatrics for Immigration Examinations must be 28 years of
age or younger*
Please secure these labs and immunizations before scheduling your appointment (the only exceptionis if your insurance is contracted with us, and you already have obtained the labs; then we are able togive you the missing the vaccines)Immunizations or Evidence of Immunity (if age appropriate):DTaP, IPV, Tdap, MMR, Varicella, Hepatitis A, Hepatitis B, Meningococcal ACWY, Influenza
- *Please see the attached immunization schedule for age-specific immunization requirements*Urine Test:- Urine toxicology screen- Urine gonorrhea/chlamydia (If 15 years and older)Blood test:- QuantiFERON Gold TB, Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP),Hepatitis B, Hepatitis C, RPR, HIV- Antibodies to diseases included in immunizations if they had past infection or diseaseo For example: If history of Chickenpox, please provide Varicella antibody labs
Please complete the form beforehand and bring a driver’s license or passport. Cost for examination is
$250 for one person and $200/person if 1+ people.
Please call our office, New Day Pediatrics, with questions at (510)465-4445. We are located at 900Colusa Avenue Suite 204 Berkeley, CA 94707. Our staff email for exchanging documents email@example.com.