Health Information - Short form

Living and learning in a developing country setting like Thailand carries with it inherent challenges. Some of those challenges are related to your health, both physical and mental/emotional health.

In order to provide the best level of care possible for our students, we need to know the unique health needs of our participants before their arrival so that we can advise students as needed about any allergies or other concerns, and how to manage those while in Thailand.

We recommend that all participants on ISDSI programs meet with their doctor and/or a travel medicine specialist before coming to determine any specific medical needs and to be sure that all vaccinations are up to date.

Please note:

Filling out this form is voluntary. However, if you do not disclose a health condition (e.g. food or medical allergy), we will be limited in what we can do to accommodate you.
There may be some medical conditions that are difficult or impossible to accommodate in Thailand. If you are not sure, please ask so that we can best prepare for your time in Thailand and care for you while on your program.
Information on this form will be kept confidential, and only used internally in the program to help advise students and to provide care for students.
This form is NOT part of the admissions process. Your acceptance or admission into your program is not contingent on your answers to this form. It is strictly to help provide support and advise to travelers to Thailand.
If you are taking any medication, it is your responsibility as a student to bring a full supply with you while on the program in original packaging with a copy of your prescription. Not all medication is available in Thailand, and medication cannot be mailed to you if you run out.

If you have any questions please email us at [email protected].

Personal Information
First Name*
Last Name*
Nickname (optional)
School*
Email*
Phone*
Medical Background
Do you have any allergies that we should know about? If yes, please describe them and what support you might need from the program. (Please note: students with severe allergies to peanuts or shellfish resulting in an anaphylactic reaction should reconsider travel to Thailand.)
Do you have any physical health concerns or limitations that we should know about (e.g. significant mobility impairments, chronic illness, etc.)? If yes, please describe them and what support you might need from the program.
Do you have any emotional or mental health issues that you would need support for while on the program? If yes, please let us know they are and how we can support you.
Is there anything else related to your health that we should know about in advance of your arrival and participation in the program?
Signature
By entering my name here and submitting this voluntary medical disclosure form, I certify that anything I have not disclosed I will be responsible for and not hold the program responsible for:
Digital Signature*

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ISDSI

Voluntary Disclosure of Health Information

Living and learning in a developing country setting like Thailand carries with it inherent challenges. Some of those challenges are related to your health, both physical and mental/emotional health.

Personal Information

Medical Background

Signature

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