About This Form
Complete this form with your nephrologist or dialysis team before your trip. Carry a printed copy at all times — it allows any international healthcare provider to understand your medical situation quickly.
What It Includes
- Full medical history summary
- Dialysis treatment details (modality, frequency, duration)
- Prescribed medications and dosages
- Allergies and contraindications
- Doctor and dialysis center contact information
Download the PDF below and fill it in with your healthcare team before departure.
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Travel with Confidence
Dialysis should not stop you from living your life. When you download the Renal Traveller app on your mobile — download on iOS or Android — you carry a digital solution in your pocket, making holiday dialysis booking simple and fast.
