Medical Practitioner Form
Please download [pdf] the printable medical form.
As you have indicated a pre existing health conditions, please download and print this form as it must be completed by your medical practitioner. Once signed, please return this form by e-mail to firstname.lastname@example.org or by fax to +1 416 260 1888
How do I complete this form?
It is very important for your own health and safety that you complete all questions fully and truthfully; we rarely have to refuse anyone a place on a trip for medical reasons, but in the event of a medical emergency, the information you have provided could be crucial. Should any such condition become apparent, we reserve the right to decline, accept or retain you or any other passenger at any time during the trip.
All passengers must complete, and return sections 'A', 'B'. In addition, those traveling to the Antarctic must complete section 'C'.
If passengers answer yes to any question in section 'B', then proceed to section 'D'. Part 1 of section 'D' must be completed by yourself, and Part 2 given to your medical practitioner to complete on your behalf. Each of you must then sign and return the entire document, sections 'A', 'B', 'C' & 'D'.