Medical Questionnaire

Let's Get Started

Please use the form below to provide information about you or the patient’s current health, treatments and/or therapies undergone to date, and any other information which will better help us to understand your medical needs.

You will need to provide copies of your most recent (within the last 30-60 days) medical records which may consist of any treatment notes from your current overseeing Health Provider, laboratory results (blood tests and/or biopsy reports), radiology reports (MRI/PET/CT scans, and/or ultrasounds), and any other health information that is pertinent to your cancer diagnosis and care.


Cancer Does NOT Wait!

Speak to Our Patient Liaisons

Let us know what questions or concerns you may have regarding our treatments, facilities, and care team.

Schedule a Consultation

Submit your medical documents and questionnaire for our team of physicians to review and propose a customized treatment protocol.

Begin Your Healing Journey

Book your travel & stay with the help of our Healing Concierge and begin the onboarding process.

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