GMAP Enroll - Canada

Congratulations! You are just a few steps away from becoming a GMAP telemedicine member. After you have completed this form, you will be contacted by a member of our sales team and then prompted to schedule your virtual appointment with a VIGILINT physician.

Reminder: For family memberships and for adults 75 years and older, please contact our Global Client Services team at GCS@VIGILINT.com

GMAP ANNUAL MEMBER PACKAGES

For online sign up, GMAP memberships are available for individuals, their spouses or domestic partners.

Please plan ahead! Travel Medical Kits will be shipped within 7-10 business days after the initial intake.

Email Address of Primary Member*

Primary Member Name *

Primary Member DOB*

Primary Member Country *

Primary Member Street Address*

Primary Member Municipality *

Primary Member Province*

Primary Member Postal Code*

Primary Member Phone Number *

Secondary Member Name (if purchasing a couple membership) (optional)

Secondary Member Date of Birth (optional)

Choose an amount

Subtotal $3,345.00

Total Amount: $3,345.00

ACCEPT TERMS: By checking the box, you agree to VIGILINT’s TERMS OF SERVICES AND PRIVACY POLICY

*Aeromedical Evacuation: Adults over 75 years of age are required to submit a medical note and subject to additional charges