Legal age / authorization

I confirm that I am of legal age to provide consent or that I am legally authorized to complete this form on behalf of the person concerned.*

Privacy Policy + Health Information + International Disclosure

I have read and accept the Privacy Policy of My Medical Getaway Inc. I authorize the use and disclosure of my personal and health information, including to independent providers located outside my country of origin or residence, in order to review my request and coordinate my file.*

Electronic Communications Related to the File

I agree to receive electronic communications related to my file, including requests for information, confirmations, documents, and administrative or logistical steps.*

Role of My Medical Getaway and Limitation of Responsibility

I understand that My Medical Getaway Inc. acts solely as an administrative and logistical coordination service and does not provide any medical care, medical advice, diagnosis, treatment, prescription, or guarantee of outcome, timeline, availability, or final medical price.*

Accuracy of Information Provided

I confirm that the information and documents provided are accurate, complete, and up to date to the best of my knowledge. I understand that incomplete or inaccurate information may delay or limit the processing of my file.*

Final choice of provider

I understand that My Medical Getaway Inc. may facilitate an introduction to certain independent providers, but that the final choice of provider is mine and that I remain free to accept, refuse or consult any other provider of my choice.*

File opening fee

I understand that the CAD $100 file opening fee is used for the initial administrative review of my request and will be credited toward the coordination package if I choose to proceed with My Medical Getaway.*