What is your primary purpose of travel ?

Your leisure activities includes?

(Choose multiple, if applicable)

Your adventure activities includes?

(Choose multiple, if applicable)

Are you planning to travel above 10000 ft?

For how much duration you will be at high altitude?

Any previous history of altitude illness(Fatigue, loss of appetite, nausea, and occasionally vomiting)?

Mode of travel

(Choose multiple, if applicable)

Have you purchased a travel insurance ?

Have you received the Visa for your travel ?

Your age

Your gender

Are you ?

Month of Pregnancy during your travel period?

Do you suffer from any Pregnancy related complications?

ft in / cm
kg / lbs

Do you have any existing health related conditions?

Select the existing health conditions

(Choose multiple, if applicable)

Do you suffer from any allergy? (Especially to vaccines, eggs, or latex)

Do you take any medications?

Are you traveling with an infant or child?

You choice of accomodation?

(Choose multiple, if applicable)

Lifestyle

Smoke

Drink

How active is your lifestyle

Your choice of food?

(Choose multiple, if applicable)

Have you taken any of the following vaccinations for your trip ?

(Choose multiple, if applicable)