Test Form

I understand, the following is required to be considered for review in our temporary travel program:

· Please note we are not a travellers clinic and only support travelers on a restricted case-by-case basis. There are a variety of reasons why we may be unable to support your request or may need to cancel a reservation. This includes: capacity at clinic, medical suitability, infection control concerns, incomplete documentation and or current / evolving risk from country of travel.

· Typically, a minimum of one month’s notice is required. We are unable to accommodate last-minute requests for travel from new patient requests

· Comprehensive tests and medical records will be required for review prior to acceptance into DMC’s travel program

· Health records are to be shared by your dialysis clinic or hospital directly with our team. As such we need a direct email or fax from the dialysis unit

· All international patients require proof of medical or health insurance to protect themselves in the event of medical emergencies

· International patients will be charged for dialysis and physician services. Payment is required in advance of treatment and fees are non-negotiable, as well as subject to change on a yearly basis.

· There is no fee for Canadian patients with valid health insurance; however pre-approval from your respective province or territory may be required.