GMAP Enroll

PLEASE FILL OUT THE Telemedicine Membership FORM BELOW TO SECURE YOUR gmap MEMBERSHIP!

Congratulations! You are just a few steps away from becoming a GMAP telemedicine member. We just need some practical information from you in order to secure your membership. After you have completed this form, you will be redirected to our payment portal and then prompted to schedule your virtual appointment with a VIGILINT physician.

GMAP ANNUAL MEMBER PACKAGES

Currently, GMAP memberships are only available for individuals or spouses/domestic partners aged 18-74. For family memberships, and for adults 75 and older, please contact sales@VIGILINT.com.

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

Email Address of Primary Member*

Primary Member Name *

Primary Member DOB *

Primary Member Street Address*

Primary Member City *

Primary Member State*

Primary Member Postal Code*

Primary Member Country *

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