Current occupation
Please tell us what your current work is.
Please give your height in metres*
If you are not familiar with metric, please Google '
5'10" in cm ' to get a conversion.
Please give your weight in KG*
Medical practitioner's name*
Please give the name of your family physician and/or primary health care provider:
Have you yourself had any formal health related training: ACLS, BLS or other?
This is just so the medic with us is fully informed.
Your experience with mountains and endurance running / hiking*
Can you briefly given an overview of your experience in the mountains and ultra-distance running and/or hiking?
How many cigarettes per day?
Please inform us how much you smoke.
Breathing problems: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Cardiovascular Conditions: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Endocrine Abnormalities: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Gastrointestinal Conditions: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Neurological Conditions: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Psychiatric/Psychological Problems: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Eyes, Ears, Nose & Throat: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Orthopaedic: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Surgical: Details, dates & medications
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications
Altitude: Further details
You answered yes to one or more of the questions above. Please elaborate here with details, dates & medications etc
Please give information about the Immunizations you've had already that cover Nepal
As a traveller in a managed group, it would be rare to contract a tropical illness, however better safe than sorry. Typhoid and Hepatitis are of particular interest. If you have questions for the medic, please also type them here.