Medical

Collecting medical information from expedition participants enables expedition organisers to prepare a suitable medical kit and guides medical decisions in the field.

The information you provide will be kept confidentially by the medical team; please complete it fully and honestly. Read through the form before you start completing it. Ask questions if you don’t understand anything. Be aware that failure to disclose a medical condition can invalidate insurance and prevent evacuation and repatriation.

    Personal

    Next of Kin

    GP Details

    Medical Questionnaire

    Immunisations

    *Please note it is the expedition members’ responsibility to ensure recommended immunisations are up to date.

    Declaration
    • I agree that the above information is true and accurate to the best of my knowledge.
    • As far as I am aware I am medically fit to partake in a remote expedition which will be both
      physically and mentally demanding and potentially include exposure to extremes of heat,
      cold and altitude.
    • I understand that I am responsible for providing all my normal medications and supplies for
      the treatment of my pre-existing medical conditions for the duration of the expedition.
    • I understand that my medical information will be kept confidential and every effort will be
      made to consult me beforehand should any disclosures be deemed necessary.
    • I agree that should I become incapable of giving consent for disclosure of essential medical
      information in the event of an emergency, information may be imparted at the discretion of
      the medical team acting in my best interests.
    • On return from the expedition, I consent to my GP being contacted with details of any
      serious illness or accident arising during the expedition.
    • I agree to discuss/disclose to the organisers any injury or illness occurring between this date
      and the date of departure.
    • I have made a copy of this completed form for my personal records.



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