Request an indicative treatment and travel plan

Share as much or as little as you like. This form is not a booking and not a diagnosis — it starts a conversation with your coordinator.

Your details

Full name

Country of residence

Helps your coordinator plan travel and time zones.

Phone or WhatsApp number

Most coordination happens on WhatsApp, but tell us in the notes if you prefer email only.

What you are considering

Treatment area

Travel timeframe

Anything you would like your coordinator to know

Please avoid sending sensitive medical detail in free text. Reports can be attached securely below.

Reference / affiliate code (optional)

If someone referred you to Mediroamers, enter their code here.

Optional: attach reports or photos

Choose files

PDF, JPG or PNG · up to 5 files · 8 MB each

Uploads are stored in private storage, shared only with the provider assessing your case, and never published.

I have read how Mediroamers handles my information and agree to be contacted about this request. I understand this is not a booking, and not medical advice. See our privacy notice.

I explicitly permit Mediroamers to share the health information and any documents I provide with the partner healthcare providers assessing my case, including providers located in Türkiye. I can withdraw this permission at any time.