Travel Letter Request

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Letter requested

Full Name*

DOB*

Email Address*

Choose Doctor*

Medications that you are currently on and doses*

Urgency*

I understand that regulations and legislations of different countries vary and that I will do my due diligence to ensure that it is legal to travel with the medications listed above in my possession.*

I understand that regulations and legislations of different countries vary and that I will do my due diligence to ensure that it is legal to travel with the medications listed above in my possession.

*Note: Some countries including, but not limited to Japan and Thailand classify dexamfetamine based medications as strictly illegal even with an accompanying doctor’s letter.

I understand that a fee of $44 (including GST) for standard turnaround and $110 (including GST) for urgent turnaround may apply to this request unless previously discussed with my psychiatrist.*

I understand that a fee of $44 (including GST) for standard turnaround and $110 (including GST) for urgent turnaround may apply to this request unless previously discussed with my psychiatrist.

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Request Urgency

Standard Request Fee

Price:

Urgent Request Fee

Price:

Credit Card*

Card Details

Cardholder Name