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.


Currently, online 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

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

Please choose your Cleveland Clinic location*
Choose an amount

Subtotal $1,675.00

Total Amount: $1,675.00

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