Consulting services information 2025

1. Click ‘Get Form’ to open the International Patient Form in the editor.
2. Begin by entering your personal details in the 'Patient Information' section. Fill in your first name, last name, gender, date of birth, and country of origin/residency.
3. Provide your height and weight, specify the unit, and indicate if an interpreter is needed along with their language.
4. Complete the contact information fields including phone number and email address. Ensure all entries are accurate for effective communication.
5. In the 'Coverage' section, select whether you will be self-paying or using international health insurance. If applicable, provide your insurance ID number.
6. Detail your original cancer diagnosis and treatment history by checking relevant boxes for chemotherapy, surgical treatments, radiation, or other therapies received.
7. Indicate the service requested such as a remote second review or clinical trial participation.
8. Fill out the 'US Visa Info & Needs' and 'Trip Detail' sections with your travel dates.
9. List any medical records you will submit for review and ensure they are organized as per instructions provided in the form.

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