GMAP Enroll

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 to schedule your virtual appointment with a VIGILINT physician.

GMAP ANNUAL MEMBER PACKAGES

Currently, online GMAP memberships are only available for individuals or spouses/domestic partners aged 18-74.

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

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

Please choose your Cleveland Clinic Location

Main Campus Executive Health
Main Campus National Consult Service
International Operations
Florida (Concierge Medicine)
Florida (Executive Health)

Email Address of Primary Member*

Primary Member Name *

Primary Member DOB *

Primary Member Country *

Primary Member Street Address*

Primary Member City *

Primary Member State*

Primary Member Postal Code*

Primary Member Phone Number *

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

Secondary Member DOB (optional)

Choose an amount

Subtotal $1,675.00

Total Amount: $1,675.00

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