Please ensure that this form is completed and signed by your usual medical practitioner.
Please complete all pages of the form.

The information you provide is essential for your health and safety on the expedition. It will remain confidential and only be seen by the expedition leader and the expedition doctor unless it becomes essential to share it with guides higher up on the mountain. The decision to disclose medical information will be taken by the expedition leader if the need should arise. The information you give will not prevent you from taking part in the expedition. If you withhold any information pertaining to medical conditions that you have or have had, you are putting yourself and all other members of the expedition at risk.