Once you and your physician have completed and signed your 'Physician Approval for Travel' form, please submit below a digital copy of the full form. It will be securely sent to International Concierge Physicians LLC, which is a team of experienced travel physicians contracted by your tour operator to review these forms, help ensure traveler safety, and provide medical services during your trip.

 

The information you provide will be kept confidential and secure, in accordance with U.S. regulations and the Health Insurance Portability and Accountability Act (HIPAA). Please contact us if you have any questions or concerns.

 

If you get an error message when uploading your form, your file is likely just very large (>15MB). Freely try to send a lower-resolution file, upload each page separately, or fax the form to us at 1-800-370-5256‬.