From Here To Care Community Initiative

VirtualTravelClinic.ca believes everyone deserves access to safe, informed travel health. Through our Safe Travels Fund, we offer free or discounted consultations to Canadians facing financial hardship, should you qualify. Please complete this short application to be considered. It takes less than 5 minutes.

Section 1: Personal Information

First Name *

Middle Name

Last Name *

Email Address *

Phone Number *

City *

Province/Territory *

Are you applying as an individual or with your family? *

Just for me

For me and my family (shared household and joint travel)

Please list each additional traveler in your household: *

How many total family members are traveling? *

How many people live in your household in total (including you)? *

Section 2: Travel Details

Destinations *

Purpose of Travel *

Visiting family for emergency reasons (e.g., illness or death)

Visiting friends/family for pleasure

Volunteering or service trip

Studying abroad

Work or internship abroad

Other

Describe 'Other' Purpose of Travel *

Please briefly describe the reason for your travel. *

Section 3: Financial Eligibility

Why are you seeking a discounted consultation through this initiative? *

Are you experiencing financial hardship?

I self-declare that I am facing financial hardship and am applying in good faith.

Section 4: Booking Info

Have you already booked a consultation with VirtualTravelClinic.ca? *

Yes

No

Please share the appointment date (or approximate date). *

How did you hear about this program? *

Describe 'Other' How did you hear about this program? *

Section 5: Consent & Privacy

I understand that the information I provide will only be used to determine eligibility for the From Here To Care Community Initiative. I consent to being contacted about my application and confirm that the information I provided is accurate to the best of my knowledge. *

I Agree

I understand that I may receive a partial or full discount depending on eligibility, and that consultation fees do not include the cost of medications or vaccines. *

I Agree

Do you have any other information you'd like to share with us?